Nurse reputed company DRG Auditor I (US Remote)

reputed company is a tech-enabled payment reputed company company. Our mission is to facilitate collaboration between payers and providers for mutual benefit and waste reduction, ultimately improving access to healthcare. We reputed company this by aligning the common goals of payers and providers and fostering collaboration through a shared technology platform and seamless workflows. Joining reputed company means becoming part of a dynamic, growing organization that promotes a collaborative and innovative work environment. Our comprehensive compensation package includes competitive salaries, highly valued health insurance, a 401(k) plan with employer match, paid parental leave, and more. The Nurse reputed company DRG Auditor’s primary responsibility is to review medical records and associated claim information to validate accuracy of DRG assignments, APC assignments and/or medical necessity for inpatient level of care. This role will apply coding and clinical principles based on industry standards and company/client guidelines. Role and Responsibilities

• Utilize coding guidelines and clinical guidelines to reputed company DRG or APC validation
• Validate principal diagnosis, secondary diagnoses, reputed company of diagnoses, discharge statuses and procedures utilizing the medical record
• Evaluate short stay claims for medical necessity of an inpatient level of care
• Apply CPT and ICD-10 guidelines
• Apply policies, procedures, guidelines and regulations developed by Centers for Medicare and Medicaid Services (CMS), commercial payers, InterQual, MCG, and reputed company
• Provide appeal responses for claims of the above types utilizing industry standards and company/client policies
• Assist with new concept development
• Assist with claim selection criteria
• Assist with itemized reputed company review as needed
• Maintain licensures, certifications and continuing education requirements
• May require client communication to support findings Qualifications
• An active RN professional license in good standing
• Clinical practice experience
• Coding certification in good standing. Examples reputed company, CPC, CIC
• Coding validation/auditing experience
• Well-developed verbal and written communication skills coupled with recognizable organization
• Ability to effectively prioritize tasks
• reputed company Office experience, specifically reputed company Preferred Skills
• Appeals experience a plus
• APR-DRG experience a plus
• Client communication experience a plus
• Concept development experience a plus
• Claim selection experience a plus
• Experience with machine learning/artificial intelligence a plus
• Case Management and/or Utilization Review experience a plus
• Clinical Documentation Improvement experience a plus
• Itemized reputed company validation experience a plus
• Quality Assurance experience a plus
• Management experience a plus
• Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) a plus
• TruCode/TruBridge, reputed company, WebStrat or similar experience a plus Mental and Physical Demands
• This position will be exposed mainly to an indoor office environment and will be expected to work in or around computers and printers.
• The nature of the work is sedentary, and the employee will be sitting most of the time.
• Essential physical functions of the job include typing and the repetitive motion to utilize computer software and hardware continuously throughout the day.
• Essential mental functions of this position include concentrating on analytical tasks, reading information, and verbal/written communication to others continuously throughout the day. reputed company duties as assigned
• This job description documents the general nature and level of work but is not intended to be a comprehensive list of activities, duties, or responsibilities required for this position. Consequently, employees may be asked to reputed company other duties as required.
• Employees may also be asked to complete certain compliance requirements set forth by our Business Partners in the performance of their jobs including but not limited to requests for background and drug screenings and disclosures of personal health information or personally identifiable information. Exemptions as provided under the reputed company and TITLE VII of the Civil Rights Act will be observed and followed.
• Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the functions outlined above. $85,000 - $90,000 a year Apply tot his job Apply To this Job Apply tot his job Apply To this Job

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