Sr. Clin Claim Review RN

Location: REMOTE Salary: $54.00 USD Hourly - $55.00 USD Hourly Description: Clinical Coding Auditor – RN Location: Remote Schedule: Standard business hours (Monday–Friday) Pay Rate: $55/hour Contract-to-Hire: High performers eligible for conversion after 3 months Start date is ASAP Contract goes through 4/24/26 and possible to go perm (4-6 months then maybe go perm depending on approvals Training will be normal business hours – CST or EST hours Primary 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 • Demonstrate knowledge of and compliance with changes and updates to coding guidelines, reimbursement trends, and client processes and requirements • Maintain and manages daily case review assignments, with a high emphasis on quality • Provide clinical support and expertise to the other investigative and analytical areas • Will be working in a high-volume production environment that is matrix driven Day in the life Auditors: coding and clinical review – 15 claims per day - Must enter auditing notes into system as well - Review any feedback that comes from sally (they send feedback often) - They can always reach out with questions - Main role is to review claims and complete queue on daily basis - They try to keep distractions on auditors at a minimum - They won’t be expected to do 15 claims right away - They will gradually increase to 15 claims per day Soft Skills: • Ability to use a Windows PC with the ability to utilize multiple applications at the same time • Demonstrate excellent written and verbal communication skills, strong analytical skills, and attention to detail • Ability to work independently in a remote environment and deliver exceptional results • Excellent time management and work prioritization skills Required Qualifications: • Unrestricted RN (registered nurse) • CCS/CIC • 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 By providing your phone number, you consent to: (1) receive automated text messages and calls from the Judge Group, Inc. and its affiliates (collectively "Judge") to such phone number regarding job opportunities, your job application, and for other related purposes. Message & data rates apply and message frequency may vary. Consistent with Judge's Privacy Policy, information obtained from your consent will not be shared with third parties for marketing/promotional purposes. Reply STOP to opt out of receiving telephone calls and text messages from Judge and HELP for help. Contact: eturner@judge.com This job and many more are available through The Judge Group. Find us on the web at www.judge.com Remote About the Company: Judge Group The Judge Group Inc., is a leading professional services firm specializing in talent, technology, and learning solutions. We consult, staff, train, and solve. Through our work we make people and organizations better. Our services are successfully delivered through a network of more than 30 offices across the United States, Canada, and India. The Judge Group is proud to partner with the best and brightest companies in business today, including over 60 of the Fortune 100. We serve organizations in financial services, healthcare, life sciences, insurance, government (including aerospace and defense), manufacturing, and technology and telecommunications. If you would like to learn more about The Judge Group visit www.judge.com or call toll free (800) 360-4474. Company Size: 5,000 to 9,999 employees Industry: Computer/IT Services Founded: 1970 Website: Apply tot his job Apply tot his job Apply To this Job