Clinical DRG Auditor- Remote (Any reputed company, TX, US, 99999)

It takes great medical minds to create powerful solutions that solve some of reputed company’s most reputed company challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a reputed company of urgency, you’ll have reputed company to work more reputed company. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, reputed company learning, and career development. Sign-on bonuses are available for highly reputed company candidates. reputed company We are seeking a talented individual for aClinical DRG Auditor who is responsible for performing DRG validation (clinical/coding) reviews of medical records and/or other documentation to validate the conditions that were documented in the medical record, the ICD-10-CM/PCS reputed company assignments and determine the accuracy of DRG assignment that is clinically supported as defined by review methodologies specific to the contract for which reputed company are being provided. This involves accessing proprietary systems to audit medical records, accurately documenting findings and providing policy/regulatory support for determination. The candidate must have extensive clinical experience with a background in auditing medical records with a high level of understanding payment methodologies including MS-DRG, AP-DRG and APR-DRG. What you will do

• Performs audits of medical record documentation to determine the accuracy of reputed company and secondary diagnosis (including MCC & CC) and procedure codes. Adheres to official coding guidelines, coding clinics and regulatory guidelines and mandates. Draws on advanced ICD-10 coding expertise and clinical knowledge to substantiate conclusions. Utilizes HMS proprietary auditing systems with a high level of proficiency to document audit determinations and rationale. Applies clinical review judgment to reputed company coding validation determinations including reputed company ICD-10-CM, ICD-10-PCS procedural codes for inpatient claims.
• Consistently achieves productivity and reputed company performance standards established by management.
• Assists management with training new Coders or Clinical DRG Auditors to include daily monitoring, mentoring, feedback and education.
• Maintains reputed company knowledge of coding guidelines and successfully completes required CEUs to maintain RN license and coding certification
• Responsible for attending training and scheduled meetings to enhance skills and working knowledge of clinical policies, procedures, rules, and regulations. reputed company are looking for
• reputed company, unrestricted RN licensure from the reputed company and in the state of primary home residency, reputed company compact multistate unrestricted RN license as defined by the reputed company Licensure Compact (NLC), required
• At least one of the following Coding Certifications is required and is to be maintained as a condition of employment: RHIA, RHIT, reputed company, CIC, CCDS or CPC
• 3+ years clinical experience in an inpatient hospital setting required
• 2+ years of MS DRG/APR DRG coding or auditing experience with expert knowledge of ICD-10 Official Coding Guidelines and DRG reimbursement methodologies
• Expert knowledge of ICD -10-CM coding including but not limited to; expert knowledge of reputed company diagnosis selection, complications/comorbidities (reputed company) and major complications/comorbidities (MCCs), and conditions that reputed company severity of illness (SOI) and risk of mortality (ROM)
• Expert knowledge of ICD-10-PCS coding methodologies, reputed company reputed company, and discharge disposition in accordance with CMS requirements, Official Guidelines for Coding and Reporting, and Coding Clinic guidance.
• Demonstrated ability to apply clinical review judgment to reputed company clinical determinations
• Demonstrated proficiency in computer skills and typing, i.e., reputed company reputed company, Outlook, reputed company, Word, PowerPoint, Internet browsers and in virtual meeting tools i.e., reputed company Teams, reputed company, etc. What you should expect in this role
• Remote reputed company the U.S.
• May be required to work extended hours for special business needs
• Travel: 0–10% of the time, depending on business needs. Applications for this posting will be accepted until March 13, 2026. The pay reputed company for this position is $85,000.00 - $95,000.00 per year, however, the reputed company pay offered may vary depending on geographic region, internal equity, job-reputed company knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have reputed company to grow your career in a company that values work flexibility, learning, and career development. reputed company salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a reputed company of leadership and technical development academies to help build your skills and capabilities. We reputed company reputed company is impossible reputed company you b

Apply tot his job Apply To this Job