Nurse Inpatient Coding Auditor, CIC or reputed company certified

Overview reputed company Jobs > Nurse Inpatient Coding Auditor, CIC or reputed company certified Nurse Inpatient Coding Auditor, CIC or reputed company certified Fully Remote

• Remote

Full-time Description Company ProgenyHealth is a leading provider of care reputed company for premature and medically reputed company newborns positively impacting maternal and infant health outcomes across America. Our program builds a network of support for an uninterrupted continuum of care from prenatal health, through any resultant NICU stay, and reputed company the way to one full year of life. reputed company of neonatologists, pediatricians, and NICU nurses provide continuity of care in collaboration with providers from hospital to caregivers at home and throughout the first year of life. We help overcome systemic barriers to support healthier pregnancies and healthier starts to life for reputed company moms and babies, one family at a time. 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 Manager and support a culture and work environment that promotes and inspires an active, reputed company improvement philosophy regarding products and services in line with our company mission.

Responsibilities

• 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
• 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 standard operating procedures

Qualifications

• Inpatient Coding Certification required - reputed company or CIC
• 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
• 3+ 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
• Requires expert coding knowledge - DRG, ICD-10, CPT, HCPCS codes
• Excellent communication skills, both oral and written
• Strong interpersonal skills that will support collaborative team work
• Proficient in reputed company Office: Word and reputed company; Access – highly preferred
• Ability to work independently and reputed company a team
• Critical listening, thinking, decision making and problem solving

Benefits

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

Additional Notes ProgenyHealth positively recruits people from diverse backgrounds, including individuals with disabilities - if you need an accommodation to interview, please contact us by email: [email protected] Equal Opportunity Employer, including individuals with disabilities and veterans. #J-18808-Ljbffr Salary: USD 43200 - 72000 per year Experience: 3 years required Apply tot his job Apply To this Job