RN DRG Coding AuditorThe Judge Group • United States
RN DRG Coding Auditor
The Judge Group • United States
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job_description.job_card.job_descriptionUnrestricted RN (registered nurse) CCS / CIC or will obtain within 6 months of hire 3+ years of MS DRG / APR DRG coding experience in a hospital environment with expert knowledge of ICD-10 Official Coding Guidelines and DRG reimbursement methodologies Expert knowledge of ICD-10-CM coding including but not limited to : expert knowledge of principal diagnosis selection, complications / comorbidities (CCs) and major complications / comorbidities (MCCs), and conditions that impact severity of illness (SOI) and risk of mortality (ROM) Expert knowledge of ICD-10-PCS coding including but not limited to : expert knowledge of the structural components of PCS including but not limited to : selection of appropriate body systems, root operations, body parts, approaches, devices, and qualifiers Experience with prior DRG concurrent and / or retrospective overpayment identification audits Experience with readmission reviews of claims Experience with DRG encoder tools (ex. 3M) Experience using Microsoft Excel with the ability to create / edit spreadsheets, use sort / filter function, and perform data entry Healthcare claims experience Managed care experience Knowledge of health insurance business, industry terminology, and regulatory guidelines
We are hiring for RN DRG Coding Auditors - Up to 17 open positions
Job title : DRG Validation RN Auditor
Work type : Contract to hire
Location : FULLY REMOTE
Rate : $55.00 per hour (firm)
This job will have the following responsibilities :
- Conduct MS-DRG and APR-DRG coding reviews to verify the accuracy of DRG assignment and reimbursement with a focus on overpayment identification
- Expert knowledge of and the ability to : identify the ICD-10-CM / PCS code assignment, appropriate code sequencing, present on admission (POA) assignment, and discharge disposition, in accordance with CMS requirements, ICD-10 Official Guidelines for Coding and Reporting, and AHA Coding Clinic guidance
- Must be fluent in the application of current ICD-10 Official Coding Guidelines and AHA Coding Clinic citations, in addition to demonstrating working knowledge of clinical criteria documentation requirements used to successfully substantiate code assignments
- Perform clinical coding review to ensure accuracy of medical coding and utilizes clinical expertise and judgment to determine correct coding and billing
- Solid command of anatomy and physiology, diagnostic procedures, and surgical operations developed from specialized training and extensive experience with ICD-10-PCS code assignment
- Writes clear, accurate and concise rationales in support of findings using ICD-10 CM / PCS Official Coding Guidelines, and AHA Coding Clinics
- Utilize proprietary workflow systems and encoder tool efficiently and accurately to make audit determinations, generate audit rationales and move claims through workflow process correctly
Qualifications & Requirements :
Preferred Qualifications :
If this interests you, apply today.
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Coding Auditor • United States