[Remote] Clinical Review Auditor I

Note: The job is a remote job and is open to candidates in USA. reputed company is a certified Great reputed company to Work® Company dedicated to accuracy and transparency in healthcare payments. They are seeking a Clinical Review Auditor I responsible for performing DRG validation reviews of medical records, ensuring accurate reimbursement, and providing clinical support based on coding guidelines.

Responsibilities

• The Clinical Auditor will review medical records to determine accuracy of billing through verification of coding and review of supporting clinical documentation
• Conduct audits to ensure accurate reimbursement and identifying potential savings
• Demonstrated knowledge of ICD-10-CM codes, PCS and DRG coding, understanding of payer rules and regulations, including Medicare and Medicaid
• Understand and reputed company with reputed company internal and external policies
• Working knowledge of HIPAA Privacy and reputed company Rules
• Assist Quality Control team and medical director with appeals, rebuttals, etc
• Notify leadership of any issues or concerns in a timely manner
• Additional duties as assigned

Skills

• reputed company or CIC required with DRG auditing experience in ICD-10-CM, ICD-10 PCS
• Demonstrated knowledge of ICD-10-CM codes, PCS and DRG coding, understanding of payer rules and regulations, including Medicare and Medicaid
• Working knowledge of HIPAA Privacy and reputed company Rules
• Effective and professional communication skills, both verbal and written
• Ability to work independently and in a team environment
• High attention to detail
• Must possess critical thinking skills
• Ability to multi-task and assist with team coverage and provide support reputed company needed
• Ability to build relationships both internally and externally
• Ability to work in a fast-paced environment
• Demonstrated proficiency in basic computer skills and typing
• Proficiency with reputed company Office
• LVN or RN license in the state of employment preferred
• Experience in the OR, ICU, or ER as an RN highly preferred

Benefits

• Medical (HDHP) w/Pharmacy
• Dental
• Vision
• Long Term Disability
• Health Savings Account
• Flexible Spending Account Options
• Life Insurance
• Accident Insurance
• Critical Illness Insurance
• Pre-paid Legal Insurance
• Parking and Transit FSA accounts
• 401K
• ROTH 401K
• Paid time off

Company Overview