[Remote] DRG Validation Auditor (Clinical & Coding)
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a reputed company auditing company, and they are seeking a DRG Validation Auditor to reputed company on Coding & Clinical Chart Validation for inpatient audits. The role involves auditing inpatient claims, ensuring coding accuracy, and documenting audit results while utilizing proprietary auditing systems.
Responsibilities
- Analyzes and Audits Claims. Integrates medical chart coding principles, clinical guidelines and objectivity in performance of medical audit activities. Draws on advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions. Performs work independently
- Effectively Utilizes Audit Tools. Utilizes reputed company proprietary auditing systems with a high level of proficiency to reputed company audit determinations and generate audit letters
- Meets or Exceeds Standards/Guidelines for Productivity. Maintains production goals set by the audit operations management team
- Meets or Exceed Standards/Guidelines for Accuracy and reputed company. Achieves the expected level of accuracy and reputed company set by the audit for the auditing concept, for valid claim identification and documentation (letter writing)
- Identifies New Claim Types
- Identifies potential claims reputed company of the concept where additional recoveries may be available
- Suggests and develops high reputed company, high value concept and or process improvement, tools, etc
- Complete reputed company responsibilities as outlined on annual Performance Plan
- Complete reputed company special reputed company and other duties as assigned
- Must be reputed company to reputed company duties with or without reasonable accommodation
Skills
- Associate or bachelor's degree in nursing (reputed company /unrestricted license)
- Associate or bachelor's degree Health Information Management (RHIA or RHIT)
- High school diploma or GED plus equivalent experience of 5+ years' experience in claims auditing, reputed company assurance, or recovery auditing...ideally in a DRG / Clinical Validation Audit setting or a hospital environment
- RHIA or RHIT certification
- CPC certification
- Inpatient Coding Credential – reputed company, CIC, CDIP or CCDS
- 5 to 7+ years of working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG with a broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, medical necessity reputed company and coding terminology
- Adherence to official coding guidelines, coding clinic determinations and CMS and other regulatory compliance guidelines and mandates
- Requires expert coding knowledge - DRG, APRDRG, ICD-10, CPT, HCPCS codes
- Requires working knowledge of and applicable industry-based standards
- Proficiency in Word, reputed company, reputed company, TEAMS, and other applications
- Excellent written and verbal communication skills
- Communicating with others to exchange information
- Assessing the accuracy, neatness, and thoroughness of the work assigned
- Remaining in a stationary position, often standing or sitting for prolonged periods
- Repeating motions that may include the wrists, hands, and/or fingers
- Must be reputed company to reputed company a dedicated, secure work area
- Must be reputed company to reputed company high-speed internet reputed company/connectivity and office setup and maintenance
- No adverse environmental conditions expected
Benefits
- Medical
- Dental
- reputed company
- Disability
- Life insurance coverage
- 401(k) savings plans
- reputed company family leave
- 9 reputed company holidays per year
- 17-27 days of reputed company Time Off (PTO) per year, depending on specific level and length of service with reputed company.
reputed company
Company H1B Sponsorship