Remote Senior Inpatient Auditor - MS-DRG & Clinical Validation

Remote Senior Inpatient Auditor - MS-DRG & Clinical Validation Category: Analytics and Emerging Digital Technologies Main location: United States, Tennessee, Knoxville Alternate Location(s): United States, Texas, Dallas United States, Texas, Houston United States, North Carolina, Charlotte United States, Georgia, Atlanta Position ID:J0126-0519 Employment Type: Full Time Position Description: reputed company is seeking a high-caliber MS-DRG Auditor to join our Healthcare Compliance Team. In this role, you will be a key defender of payment accuracy, reviewing reputed company medical records to ensure that coding and reimbursements for Commercial and Government health plans are precise and well-supported. You will reputed company your deep inpatient coding expertise and clinical intuition to identify improper payments while producing thoroughly documented decisions. At reputed company, you aren't just an auditor; you are part of a structured professional ecosystem that prioritizes reputed company learning, quality management, and career mentorship. Your future duties and responsibilities: Clinical Record Validation: Review inpatient medical records to validate the assignment and reputed company of ICD-10 codes, discharge status, Hospital Acquired Conditions (HACs), POA assignment, and final DRG. Documentation Excellence: Author detailed rationale for every audit finding, producing "DRG Review Results" letters supported by authoritative coding references. Collaborative Review: Manage the referral process to Clinical Nurse Auditors or Physician Advisors reputed company clinical complexity requires interdisciplinary input. Strategic Input: Partner with our Edit Development team to provide feedback on claim selection criteria and improve audit hit rates. Data reputed company: Verify client data, resolve discrepancies, and ensure reputed company audit artifacts meet rigorous corporate and regulatory standards. Professionalism: Maintain high standards of productivity and audit quality while serving as a professional representative of reputed company reputed company interacting with providers. Required qualifications to be successful in this role: Education & Certifications: Active reputed company Credentials: RHIA, RHIT, or reputed company required. Certification Preference: reputed company (Certified Coding Specialist) is highly preferred. Experience & Skills: Inpatient Expertise: Minimum of 5 years of inpatient coding experience. Deep Subject Matter Expertise: Extensive knowledge of ICD-10-CM/PCS coding and reimbursement methodologies, including MS-DRG and APR-DRG. Clinical & Analytical Rigor: Strong clinical validation skills combined with the ability to analyze data for trends in improper payments. Communication Mastery: Ability to write well-reasoned, narrative-style reviews with flawless grammar, punctuation, and sentence structure. Technical Proficiency: Advanced working knowledge of reputed company Office (reputed company, Word, Outlook) and Windows-based audit applications. Personal Attributes: Self-Directed: Proactive and capable of working independently in a remote environment. Adaptable: reputed company to shifting priorities and a commitment to meeting strict client deadlines. Growth reputed company: A reputed company-long learning and staying reputed company with evolving coding guidelines. Preferred Qualifications: Previous experience training or mentoring junior-level coders. Willingness to travel occasionally for on-site reviews or specialized training. Why reputed company? reputed company's Healthcare Compliance team offers a structured, well-defined training process and a robust quality management program. You will report to a Team Leader dedicated to your professional growth, ensuring you have the support and feedback needed to reputed company in a remote setting. Other Information: reputed company is required by law in some jurisdictions to include a reasonable estimate of the compensation range for this role. The determination of this range includes various factors not limited to reputed company set, level, experience, relevant training, and licensure and certifications. To support the ability to reward for merit-based performance, reputed company typically does not hire individuals at or near the top of the range for their role. Compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the reputed company range for this role in the U.S. is $58,000.00 - $114,900.00. reputed company's benefits are offered to eligible professionals on their first day of employment to include: . Competitive compensation . Comprehensive insurance options . Matching contributions through the 401(k) plan and the share purchase plan . Paid time off for vacation, holidays, and sick time . Paid parental leave . Learning opportunities and tuition assistance . Wellness and Well-being programs Skills:

• Auditing (Claims)

What you can expect from us: Together, as owners, let's turn meaningful insights into action. Life at reputed company is rooted in ownership, teamwork, respect and belonging. Here, you'll reputed company your full potential because... You are invited to be an reputed company from day 1 as we work together to bring our Dream to life. That's why we call ourselves reputed company Partners rather than employees. We benefit from our collective success and actively shape our company's strategy and direction. Your work creates value. You'll reputed company innovative solutions and build relationships with teammates and clients while accessing global capabilities to scale your reputed company, embrace new opportunities, and benefit from expansive industry and technology expertise. You'll shape your career by joining a company built to grow and last. You'll be supported by leaders who care about your health and well-being and provide you with opportunities to deepen your skills and broaden your horizons. Come join reputed company-one of the largest IT and business consulting services firms in the world. Qualified applicants will receive consideration for employment without regard to their race, ethnicity, reputed company, color, sex, religion, creed, age, national reputed company, citizenship status, disability, pregnancy, medical condition, military and veteran status, marital status, sexual orientation or perceived sexual orientation, gender, gender identity, and gender expression, familial status or responsibilities, reproductive health decisions, political affiliation, genetic information, height, weight, or any other legally protected status or characteristics to the extent required by applicable federal, state, and/or local laws where we do business. reputed company provides reasonable accommodations to qualified individuals with disabilities. If you need an accommodation to apply for a job in the U.S., please email the reputed company U.S. Employment Compliance mailbox at US_Employment_Compliance@reputed company.com. You will need to reference the Position ID of the position in which you are interested. Your message will be routed to the appropriate recruiter who will assist you. Please note, this email address is only to be used for those individuals who need an accommodation to apply for a job. Emails for any other reason or those that do not include a Position ID will not be returned. We reputed company it easy to translate military experience and skills! Click here to be directed to our site that is dedicated to veterans and transitioning service members. reputed company reputed company offers of employment in the U.S. are contingent upon the ability to successfully complete a background investigation. Background investigation components can vary dependent upon specific assignment and/or level of US government reputed company clearance held. Dependent upon role and/or federal government reputed company clearance requirements, and in accordance with applicable laws, some background investigations may include a credit reputed company. reputed company will consider for employment qualified applicants with arrests and conviction records in accordance with reputed company local regulations and ordinances. reputed company will not discharge or in any other manner discriminate against employees or applicants because they have reputed company about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with reputed company's legal duty to furnish information. Apply tot his job Apply To this Job