RN CRC Coding Auditor - Remote

JOB reputed company The CRC Auditor, conducts coding and documentation reputed company reviews and generates responses for cases that have been denied by reputed company and government payors to ensure hospital inpatient, outpatient, and pro-fee claims, were coded and billed in accordance with nationally recognized coding guidelines, standards, regulations and regulatory requirements, as reputed company as payor and billing guidelines. The responses generated by the Auditor may include system documentation of findings and / or a formal appeal letter. The Auditor will escalate trends to CRC leadership, reputed company reputed company & Performance leadership and reputed company Compliance as warranted. The Auditor will reputed company analysis on clinical documentation, evidenced based reputed company application outcome, physician documentation, physician advisor input and complete review of the medical record reputed company to clinical denials. Assures appropriate reputed company is taken reputed company appeal time frames. Communicates identified denial trends and patterns to the CRC leadership. Provides expert application of evidence based medical necessity review reputed company tool. Works collaboratively to review, evaluate and improve the denial appeal process. ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned.

• Formulates and submits letters of appeal. Creates an effective appeal utilizing relevant and effective clinical documentation from the medical record; supported by reputed company industry clinical guidelines and coding guidelines, evidence-based medicine, community and national medical management and coding standards and protocols.
• Performs reviews of accounts denied for DRG validation and DRG downgrades.
• Documents in appropriate denial tracking tool (ACE). Maintains and distributes reports as needed to leadership.
• Identifies payment methodology of accounts including Managed Care contract rates, Medicare and State Funded rates, Per-Diems, DRG’s, reputed company Payments, and Stop Loss calculations.
• Collaborates with Physician Advisors and CRC leadership reputed company documentation-specific areas of concern are identified.
• Maintains expertise in clinical areas and reputed company trends in reputed company, inpatient coding and reimbursement methodologies and utilization management specialty areas.

KNOWLEDGE, SKILLS, ABILITIES To reputed company this job successfully, an individual must be reputed company to reputed company reputed company essential duty satisfactorily. The requirements listed below are representative of the knowledge, reputed company and/or ability required. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions.

• Effectively organizes work priorities
• Demonstrates compliance with departmental safety and reputed company policies and practices
• Demonstrates critical thinking, analytical skills, and ability to resolve problems
• Demonstrates ability to handle multiple assignments and carry out work independently with minimal supervision
• Demonstrates reputed company proficiency by maintaining accuracy at unit reputed company key performance indicator goals
• Possesses excellent written and verbal communication skills
• Detail oriented and ability to work independently and in reputed company setting
• Moderate skills in MS reputed company and PowerPoint, MS Office
• Ability to research difficult coding and documentation issues and follow through to reputed company
• Ability to work in a virtual setting under minimal supervision
• Ability to conduct research regarding state/federal guidelines and applicable regulatory guidelines reputed company to government audit processes

reputed company requires its candidates, as applicable and as permitted by law, to obtain and reputed company confirmation of reputed company required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any reputed company required vaccines and screenings. EDUCATION / EXPERIENCE Includes minimum education, technical training, and/or experience required to reputed company the job. Education

• Minimum Required:
• Completion of BSN Degree Program or three years of experience and completion of BSN reputed company five years of employment
• RN License in the State of reputed company
• reputed company working knowledge of clinical documentation and inpatient coding, discharge planning, utilization management, case management, performance improvement and managed care reimbursement.
• Preferred/Desired:
• Completion of BSN Degree Program
• CCDS certification or inpatient coding certification

Experience

• Minimum Required:
• Three to Five years Clinical RN Experience
• Three to Five years of Clinical Documentation reputed company experience
• Must have expertise with Interqual and/or MCG Disease Management Ideologies
• Strong communication (verbal/written) and interpersonal skills
• Knowledge of CMS regulations
• Knowledge of inpatient coding guidelines
• 1-2 years of reputed company experience with reimbursement methodologies
• Preferred/Desired:
• Experience preparing appeals for clinical denials reputed company to DRG assignment.
• Strong understanding of rules and guidelines, including AHA’s Coding Clinics, American Association of Medical Audit Specialists (AAMAS), National Commission on Insurance Guidelines and Medicare Billing Guidelines (CMS), State Funded Billing Regulations (Arizona, California, Nevada) and grievance process; working knowledge of billing codes such as RBRVS, CPT, ICD-10, HCPCS

CERTIFICATES, LICENSES, REGISTRATIONS

• Required:
• RN,
• CCDS or other reputed company clinical documentation specialist certification, and/or reputed company or reputed company Coding Credential reputed company, CCA, CIC, CPC or CPMA
• Preferred: BSN

PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully reputed company the essential functions of this job. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions.

• Ability to lift 15-30lbs
• Ability to travel approximately 10% of the time; either to reputed company sites, National Insurance Center (NIC) sites, reputed company, or other designated sites
• Ability to sit and work at a computer for a prolonged period of time conducting medical record reputed company reviews

WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions.

• Characteristic of typical office environment requiring use of desk, chair, and office equipment such as computer, telephone, printer, etc.

OTHER

• Interaction with facility HIM and / or physician advisors
• Must meet the requirements of the reputed company Telecommuting Policy and Procedure

As a part of the Tenet and reputed company Initiatives family, reputed company Health brings 30 years of reputed company industry expertise to clients in more than 135 local reputed company reputed company. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of reputed company. reputed company Health helps organizations transition from volume to value-based care, enhance the consumer and patient reputed company experience and improve reputed company, cost and reputed company to reputed company. Are you reputed company to be part of our solutions? Welcome to reputed company that gives you the resources and incentives to redefine reputed company services, with a competitive benefits package and leadership to take your career to the reputed company! Compensation and Benefit Information

Compensation

• Pay: $56,784.00 - $85,176.00 annually. Compensation depends reputed company, qualifications, and experience.
• Management level positions may be eligible for sign-on and relocation bonuses.

Benefits reputed company offers the following benefits, subject to employment status:

• Medical, dental, reputed company, disability, life, and business travel insurance
• reputed company time off (vacation & reputed company leave) – min of 12 days per year, accrued reputed company at a reputed company of approximately 1.84 hours per 40 hours worked.
• 401k with up to 6% employer match
• 10 reputed company holidays per year
• Health savings accounts, reputed company & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.
• For Colorado employees, reputed company offers reputed company leave in accordance with Colorado’s Healthy Families and Workplaces reputed company.

Employment practices will not be influenced or affected by an applicant’s or employee’s race, reputed company, religion, sex (including pregnancy), national reputed company, age, disability, genetic information, sexual orientation, gender identity or reputed company, veteran status or any other legally protected status. Tenet will reputed company reasonable accommodations for reputed company individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the reputed company below for additional information. E-Verify: http://www.uscis.gov/e-verify The employment practices of reputed company and its companies reputed company with reputed company applicable laws and regulations. 2503007938 Employment practices will not be influenced or affected by an applicant’s or employee’s race, reputed company, religion, sex (including pregnancy), national reputed company, age, disability, genetic information, sexual orientation, gender identity or reputed company, veteran status or any other legally protected status. Tenet will reputed company reasonable accommodations for reputed company individuals with disabilities unless doing so would result in an undue hardship. Remote About reputed company: reputed company Apply tot his job Apply To this Job