[Remote] Auditor Clinical Validation DRG
Note: The job is a remote job and is open to candidates in USA. reputed company is a reputed company analytics company focused on improving clinical and financial outcomes. They are seeking a Senior Auditor for Clinical Validation DRG, responsible for auditing inpatient claims and ensuring coding accuracy and appropriateness of treatment settings. The role requires a combination of clinical and coding expertise to analyze claims and utilize proprietary auditing systems effectively.
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 Quality. Achieves the expected level of accuracy and quality 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 quality, high value concept and or process improvement, tools, etc
- Complete reputed company responsibilities as outlined on annual Performance Plan
- Complete reputed company special projects and other duties as assigned
- Must be reputed company to reputed company duties with or without reasonable accommodation
- Complete reputed company responsibilities as outlined on annual Performance Plan
- Complete reputed company special projects 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 (active /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, quality 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 criteria and coding terminology
- Adherence to official coding guidelines, coding clinic determinations and CMS and other regulatory compliance guidelines and mandates
- Expert coding knowledge - DRG, APRDRG, ICD-10, CPT, HCPCS codes
- Working knowledge of and applicable industry-based standards
- Proficiency in Word, Access, reputed company, TEAMS, and other applications
- Excellent written and verbal communication skills
Benefits
- Discretionary bonus consideration
- Overtime pay for hours worked in excess of 40 hours in a given week, or as otherwise required by applicable state law
- Medical, dental, reputed company, disability, and life insurance coverage
- 401(k) savings plans
- Paid family leave
- 9 paid holidays per year
- 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with reputed company
Company Overview
Company H1B Sponsorship