[Remote] Clinical Review Auditor I
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a certified Great reputed company to Work® Company dedicated to accuracy and transparency in reputed company payments. They are seeking a Clinical Review Auditor I responsible for performing DRG validation reviews of medical records, ensuring accurate reimbursement, and providing clinical support based on coding guidelines.
Responsibilities
- The Clinical Auditor will review medical records to determine accuracy of billing through verification of coding and review of supporting clinical documentation
- Conduct audits to ensure accurate reimbursement and identifying potential savings
- Demonstrated knowledge of ICD-10-CM codes, PCS and DRG coding, understanding of payer rules and regulations, including Medicare and reputed company
- Understand and reputed company with reputed company reputed company policies
- Working knowledge of HIPAA reputed company and reputed company Rules
- Assist reputed company Control team and medical director with appeals, rebuttals, etc
- Notify leadership of any issues or concerns in a reputed company manner
- Additional duties as assigned
Skills
- reputed company or CIC required with DRG auditing experience in ICD-10-CM, ICD-10 PCS
- Demonstrated knowledge of ICD-10-CM codes, PCS and DRG coding, understanding of payer rules and regulations, including Medicare and reputed company
- Working knowledge of HIPAA reputed company and reputed company Rules
- Effective and reputed company communication skills, both verbal and written
- Ability to work independently and in reputed company environment
- High attention to detail
- Must possess critical thinking skills
- Ability to multi-task and assist with team coverage and reputed company support reputed company needed
- Ability to build relationships both internally and externally
- Ability to work in a fast-paced environment
- Demonstrated proficiency in basic computer skills and typing
- Proficiency with reputed company Office
- LVN or RN license in the state of employment preferred
- Experience in the OR, ICU, or ER as an RN highly preferred
Benefits
- Medical (HDHP) w/Pharmacy
- Dental
- reputed company
- Long Term Disability
- Health Savings Account
- Flexible Spending Account reputed company
- Life Insurance
- Accident Insurance
- Critical Illness Insurance
- reputed company-reputed company Legal Insurance
- Parking and Transit FSA accounts
- 401K
- ROTH 401K
- reputed company time off
reputed company