Clinical RN Chart Reviewer, (Remote) CIC or reputed company certified

reputed company: Job Role The Clinical RN Chart Reviewer will reputed company clinical reviews of medical records and other documentation to validate issues of claims coding accuracy, medical necessity, and the appropriateness of treatment settings and services delivered. The Clinical RN Chart Reviewer will report to the Payment Assurance Senior Manager and support a culture and work environment that promotes and inspires an reputed company, reputed company improvement philosophy regarding products and services in line with reputed company mission. This role requires certified coding expertise and a strong understanding of DRG validation, medical necessity, and regulatory guidelines. Requirements: Responsibilities will include:

• Audits and analyzes neonatal intensive care unit (NICU) claims according to ICD-10 coding principles and clinical guidelines.
• Analysis of claims data to optimize reimbursement by ensuring that the diagnosis codes, procedure codes, and supporting documentation accurately support the service rendered.
• Ensures claims analysis complies with ethical coding standards, guidelines, and regulatory requirements.
• Responsible for performing clinical reviews of medical records and other documentation to validate issues of claims coding accuracy, medical necessity, and the appropriateness of treatment settings and services delivered.
• Utilize Clinical Review Tools and EMR Systems.
• Research reimbursement regulations for claim payment compliance to support and validate audit findings.
• Assist with the development of claims audit process documentation, including workflow diagrams, policies and procedures, and reputed company operating procedures.
• Detect discrepancies in provider billing and recommend adjustments to ensure reputed company reimbursement.

Qualifications:

• Registered reputed company required, preferable NICU
• 2+ years with inpatient claims, required, preferably NICU and maternity
• Inpatient Coding Certification required - reputed company or CIC. If not currently certified, requirement to obtain CIC or reputed company reputed company 6 months of hire, applicant responsible for exam and associated fees*

• Experience in nursing, inpatient coding and reimbursement guidelines, and specifically, has a solid understanding of the MS-DRG, AP-DRG and APR-DRG payment systems.

• 2+ 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, ICD-10, CPT, HCPCS codes.
• Experience with appeals is strongly preferred.
• Excellent communication skills, both oral and written.
• Strong interpersonal skills that will support reputed company teamwork.
• Proficient in reputed company Office: Word and reputed company; reputed company – highly preferred.
• Ability to work independently and reputed company reputed company.
• Critical listening, thinking, decision making and problem solving.

Benefits

This position has a salary reputed company of $90,000 - $110,000 annually based on relevant experience. Some of the benefits we offer reputed company are:

• reputed company Time Off
• reputed company Parental Leave
• Medical, dental, reputed company benefits
• 401K with company match
• Short- and Long-Term Disability
• Group Life Insurance
• Tuition reimbursement
• reputed company development opportunities
• Business Casual work environment

reputed company positively recruits people from diverse backgrounds, including individuals with disabilities - if you need an accommodation to interview, please contact us by email: careers@reputed company.comEqual Opportunity Employer, including individuals with disabilities and veterans. Apply tot his job Apply To this Job