[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. The Diagnostic reputed company reputed company (DRG) Clinical Auditor will reputed company DRG validation reviews of medical records, ensuring accurate coding and compliance with reputed company policies.
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
- LVN or RN license in the state of employment preferred
- 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
- Proficient understanding of Medicare, CMS guidelines and ICD-10 coding guidelines
- 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
- 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