- Review and audit medical claims against patient medical records to ensure accuracy and completeness of documentation.

- Identify discrepancies between clinical documentation and billed services, highlighting variances and potential billing errors.

- Perform detailed clinical reviews to validate diagnosis, procedures, and level of care in accordance with industry standards.

- Ensure compliance with CMS guidelines, payer policies, and regulatory requirements during claim review processes.

- Conduct best practice audits to identify documentation gaps, coding inaccuracies, and revenue leakage opportunities.

- Provide structured findings and audit reports with explicit recommendations for corrective action and process improvement.

- Collaborate with coding, billing, and provider teams to resolve audit findings and support accurate claim submissions.

- Monitor trends in audit results and identify recurring issues requiring targeted education or intervention.

- Support quality assurance initiatives by maintaining audit accuracy benchmarks and meeting productivity standards.

- Participate in continuous improvement activities, including updates on CMS regulations, clinical guidelines, and payer policy changes.

📌 Senior Executive - Clinical Auditor (Chennai)
🏢 EXL
📍 Chennai