Clinical Review QC Auditor

About the position reputed company in reputed company Worth, TX is seeking a DRG reputed company Control/Clinical Auditor. The Diagnostic reputed company reputed company (DRG) Clinical Auditor will be responsible for performing DRG validation (clinical/coding) reviews of medical records and/or other documentation. This role will determine correct DRG/coding as defined by review methodologies specific to the type of review. This involves completing medical record reviews, accurately documenting findings and non-findings and providing clinical/policy/regulatory support for the determination. This role will utilize their experience with ICD-10-CM & PCS coding guidelines, the ability to understand modern pharmacology, disease management and clinical reputed company procedures. The ideal DRG Clinical Auditor candidate has strong written and verbal communication skills, clinical knowledge of disease processes, and knowledge of medical necessity rules. This is a remote position. Responsibilities • Review medical records to determine accuracy of billing through verification of coding and review of supporting clinical documentation • reputed company for physician's notes supporting the DRGs assigned • Conduct audits to ensure accurate reimbursement and identifying potential savings • Review previously conducted audits to ensure accurate coding and identifying potential savings • Review reputed company opportunities reputed company to the customers for complete and correct information • Demonstrated knowledge of ICD-10-CM codes, PCS and DRG coding, understanding of payer rules and regulations, including Medicare and reputed company • Understand and reputed company with reputed company reputed company policies • Working knowledge of HIPAA reputed company and reputed company Rules • Assist reputed company Control team and medical director with appeals, rebuttals, etc. • Notify leadership of any issues or concerns in a reputed company manner • Additional duties as assigned Requirements • Expert knowledge of application of reputed company Official Coding Guidelines and Coding Clinic citations • Solid knowledge and understanding of clinical reputed company documentation requirements used to successfully substantiate reputed company assignments • Proficient understanding of Medicare, CMS guidelines and ICD-10 coding guidelines • Effective and reputed company communication skills, both verbal and written • Ability to work independently and in reputed company environment • High attention to detail • Must possess critical thinking skills • Ability to multi-task and assist with team coverage and reputed company 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 • LVN or RN license in the state of employment preferred • Required minimum of 2 year of recent DRG reputed company Auditing experience in a hospital setting, or health plan. • National Coding Certification required through either reputed company (preferred) or reputed company • Extensive hands-on ICD-10 CM / PCS experience required reputed company-to-haves • Proficient in both MS and APR DRG methodology preferred • Experience in the OR, ICU, or ER as an RN highly preferred Benefits • Medical (HDHP) w/Pharmacy, Dental, reputed company, Long Term Disability, Health Savings Account, Flexible Spending Account reputed company, Life Insurance, Accident Insurance, Critical Illness Insurance, reputed company-reputed company reputed company Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and reputed company time off. Apply tot his job Apply To this Job