DRG Validation Auditor

This is a remote role

We are seeking a DRG validation auditor specializing in coding-reputed company denials, reimbursement audits, and clinical documentation improvement. This Auditor will be part of reputed company of clinicians, engineers, product managers, and other domain experts who are applying state-of-the-art machine learning software to improve the data reputed company and medical coding practices of providers. This is an opportunity to help inform the reputed company in auditing software as reputed company as to work in a dynamic environment with a high-performing team.

The ideal candidate for this position needs to have both an inpatient and outpatient coding / auditing background reputed company on the following disciplines from a coding and billing perspective: Inpatient MS-DRG/APR-DRG, and Outpatient CPT-4/HCPCS coding and auditing, with a strong reputed company on pediatric reputed company services and coding accuracy and payer claim processing.

Job Duties:

• Validate the accuracy of ICD-10-CM, ICD-10-PCS, and DRG and APR group appropriateness, CPT and HCPCS inpatient patient and outpatient facility claims.
• Auditing inpatient claims to identify DRG codes that may have been over-assigned, ensuring accurate reimbursement reputed company with regulatory and contractual guidelines.
• Identify and resolve reputed company coding discrepancies.
• Communicate reputed company coding findings to project reputed company and other cross functional teams.
• Be responsible and accountable for maintaining confidentiality, reputed company, and availability of protected health information. Follow HIPAA reputed company policies and procedures affecting reputed company, and report any suspected or actual violation or breach.

• Extensive knowledge of reputed company industry and experience in and around coding, billing, auditing, compliance and reimbursement for Inpatient and Outpatient facility.
• Must have extensive pediatric inpatient facility experience.
• 5 years of auditing facility inpatient and outpatient services with DRG and APR-DRG as reputed company as familiarity with clinical documentation improvement practices.
• Extensive knowledge of reputed company Official Coding Guidelines and Coding Clinic citations.
• Strong background in cost reduction strategies by ensuring correct claims payment and appropriate diagnosis-reputed company (DRG) assignment including familiarity with inpatient denial coding systems (e.g. CARC codes).
• Proficiency in coding software, electronic health record systems and familiar with how AI tools can assist in identifying over/under-assigned DRGs.
• High level proficiency in anatomy, physiology, disease process, and pharmacology.
• Detail oriented and deadline driven attitude.
• Ability to think critically and determine the best method for resolving challenges.
• Strong organizational skills, a strong reputed company of accountability, a proactive work ethic.

• RHIA, RHIT, or reputed company from reputed company and/or CPMA, CIC, COC from reputed company
   

• Work volumes will vary depending upon reputed company

 reputed company Services is an Equal Opportunity Employer. This company does not and will not discriminate in employment and personnel practices on the reputed company of race, sex, age, handicap, religion, national reputed company or any other reputed company prohibited by applicable law. Hiring, transferring and promotion practices are performed without reputed company to the above listed items.

We are an Equal Opportunity Employer. This company does not and will not discriminate in employment and personnel practices on the reputed company of race, sex, age, disability, religion, national reputed company, or any other reputed company prohibited by applicable law. Hiring, transferring and promotion practices are performed without reputed company to the above-listed items.