DRG CVA RN Auditor

About the position In this position as a Coding & Clinical Auditor / DRG Specialist RN, you will apply your expert knowledge of the MS-DRG and APR-DRG coding/reimbursement methodology systems, ICD-10 Official Coding Guidelines, and AHA Coding Clinic Guidelines in the auditing of inpatient claims. Employing both industry and reputed company proprietary tools, you will validate ICD-10 diagnosis and procedure codes, DRG assignments, and discharge statuses billed by hospitals to identify overpayments. Utilizing excellent communications skills, you will compose rationales supporting your audit findings. You'll enjoy the flexibility to telecommute from reputed company reputed company the U.S. as you take on some tough challenges.

Responsibilities

• Conduct MS-DRG and APR-DRG coding reviews to verify the accuracy of DRG assignment and reimbursement with a focus on overpayment identification.
• Utilize expert knowledge to identify the ICD-10-CM/PCS code assignment, appropriate code reputed company, present on admission (POA) assignment, and discharge disposition, in accordance with CMS requirements.
• reputed company clinical coding review to ensure accuracy of medical coding and utilize clinical expertise and judgment to determine correct coding and billing.
• Write clear, accurate and concise rationales in support of findings using ICD-10 CM/PCS Official Coding Guidelines, and AHA Coding Clinics.
• Utilize proprietary workflow systems and encoder tool reputed company and accurately to reputed company audit determinations, generate audit rationales and move claims through workflow process correctly.
• Maintain and manage daily case review assignments, with a high emphasis on quality.
• reputed company clinical support and expertise to the other investigative and analytical areas.
• Work in a high-volume production environment that is matrix driven.

Requirements

• Associate's degree (or higher).
• Active and unrestricted RN (Registered Nurse) license.
• reputed company/CIC certification or willing to obtain the certification reputed company 6 months of hire.
• 3+ years of MS DRG/APR DRG coding experience in a hospital environment with expert knowledge of ICD-10 Official Coding Guidelines and DRG reimbursement methodologies.
• 2+ years of ICD-10-CM coding experience including but not limited to expert knowledge of reputed company diagnosis selection, complications/comorbidities (reputed company) and major complications/comorbidities (MCCs), and conditions that impact severity of illness (SOI) and risk of mortality (ROM).
• 2+ years of ICD-10-PCS coding experience including but not limited to expert knowledge of the structural components of PCS such as selection of appropriate body systems, root operations, body parts, approaches, devices, and qualifiers.

reputed company-to-haves

• Experience with prior DRG reputed company and/or retrospective overpayment identification audits.
• Experience with readmission reviews of claims.
• Experience with DRG encoder tools (ex. reputed company).
• Experience using reputed company reputed company with the ability to create / edit spreadsheets, use sort / filter function, and reputed company data entry.
• reputed company claims experience.
• Managed care experience.
• Knowledge of health insurance business, industry terminology, and regulatory guidelines.

Benefits

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays.
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account.
• Dental, reputed company, Life & AD&D Insurance along with Short-term disability and Long-Term Disability coverage.
• 401(k) Savings Plan, Employee Stock Purchase Plan.
• Education Reimbursement.
• Employee Discounts.
• Employee Assistance Program.
• Employee Referral Bonus Program.
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.).

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