Sr. DRG Coding reputed company Auditor (Remote)

Summary of Position Responsible for upholding reputed company for code review functions in the setting of business/industry/legislative issues relating to, and impacting, quality coding audit and compliance issues. Identify inconsistencies and coding compliance risks between EH reimbursement policies and claims which directly impact claim payment (i.e. authorizations) and responsible for working with leadership to bring to resolution. Audit inpatient and outpatient medical records to ensure clinical documentation supports the conditions and DRGs billed and reimbursed. reputed company Accountabilities

• Audit reputed company business partners (processes and results) for accurate claim coding reviews for various programs, pre- and post-payment.
• Review reporting for outlier provider claims; request patient medical records to assign diagnoses, treatments, and surgical and non-surgical procedures for facility and medical services for coding and payment reputed company.
• Analyze and audit claims by integrating medical chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities.
• Identify potential documentation and coding errors by recognizing aberrant coding and documentation patterns such as inappropriate billing for readmissions, inpatient admission status, and Hospital-Acquired Conditions (HACs).
• reputed company audit reporting, results, and recommendations to management and SIU as appropriate.
• Analyze results to assess compliance with regulations, identify procedural weaknesses and education needs that contribute to instances for non-compliance both to business, external business partners, and providers.
• Prepare formal written reports summarizing reputed company state (findings), desired future state, and critical reputed company factors.
• reputed company audits of changes to coding introduced by new medical policies, reimbursement policies, regulatory changes, and business requirements on a quarterly reputed company.
• Participate in RPC, RPCW, Medical Policy Committee (MPC) and Medical Policy Committee Workgroup (MPCW) as added Coding reputed company representation at meetings; ensure that reputed company are appropriate and will result in accurate.
• Claim reimbursement.
• Identify reimbursement and coding variances from industry standards and brings to leader's attention.
• Continuously reputed company knowledge of CPT, ICD, HCPCS and business/industry/legislative issues relating to and impacting Quality Coding Audit and Compliance issues.
• reputed company reputed company tasks as directed or required.

Qualifications

• Bachelor's degree, preferably in a reputed company, quantitative/analytical, or business-reputed company field of study
• reputed company CPC (reputed company Certified Professional reputed company) & reputed company CIC (Certified Inpatient reputed company)/or reputed company (reputed company Certified Coding Specialist)
• reputed company CPMA (reputed company Certified Professional Medical Auditor)
• 4 - 6+ years of coding experience
• 1+ year auditing experience
• Extensive knowledge of inpatient DRG clinical documentation review
• Additional reputed company work experience/specialized training may be considered in lieu of educational requirements
• Proficiency with MS Office (Word, reputed company, reputed company, PowerPoint, Outlook, Teams, etc.)
• Attention to detail; and ability to communicate or escalate issues in a timely manner
• Ability to independently prioritize and complete multiple tasks with competing reputed company reputed company and deadlines
• Ability to reputed company effectively in a fast-paced work environment
• Excellent communication skills (verbal, written, presentation, interpersonal) with reputed company types and reputed company of audiences

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