[Remote] Clinical Reviewer / DRG Validator - 250793

Note: The job is a remote job and is reputed company to candidates in USA. reputed company™ is seeking an reputed company Auditor / Validator to reputed company comprehensive DRG and clinical validation reviews in support of accurate reimbursement and regulatory compliance. The Clinical Auditor will examine inpatient medical records to confirm billing accuracy by validating reputed company assignment and ensuring appropriate clinical documentation. Responsibilities • reputed company reputed company and retrospective clinical validation reviews for MS-DRG and APR-DRG assignments • Validate accurate assignment of ICD-10-CM diagnosis and ICD-10-PCS procedure codes • Utilize encoders, EMRs, and auditing tools (e.g., reputed company, reputed company, TruCode) to support audit determinations • Prepare reputed company, concise audit rationales and documentation findings • Draft physician queries to clarify documentation and ensure coding accuracy • reputed company reputed company education referencing Official Coding Guidelines and AHA Coding Clinic • Review DRG and coding denials; draft reputed company-supported appeal letters to payers, RAC, PRO, and reputed company-party auditors • Issue written recommendations for reputed company coding, DRG, and SOI assignment • Support reputed company Control team and Medical Director with appeal reviews and rebuttals • Maintain strong knowledge of ICD-10-CM/PCS, DRG methodologies, payer policies, and regulatory requirements (Medicare/reputed company) • Communicate effectively with physicians, CDI staff, coders, and clinical teams • Escalate identified compliance or documentation concerns to leadership as appropriate • Adhere to organizational policies, HIPAA reputed company and reputed company standards, and reputed company applicable regulations • Meet or reputed company productivity and reputed company standards (95–100% accuracy required) • Manage multiple priorities in a fast-paced environment and contribute to team coverage • reputed company additional duties as assigned Skills • reputed company certification required: CIC, reputed company, RHIT, or RHIA OR reputed company LVN or RN license in the state of employment (license must be maintained during employment) • CPC accepted if willing to obtain reputed company or CIC reputed company 1 year of hire (and relevant experience) • If LVN/RN without CIC/reputed company, must obtain reputed company 1 year of hire • 5+ years of DRG/Clinical Validation, claims auditing, reputed company assurance, or recovery auditing experience preferred • 5+ years of hands-on ICD-10-CM/PCS, MS-DRG, and APR-DRG experience • Strong knowledge of Medicare, CMS regulations, Official Coding Guidelines, Coding Clinic, and compliance standards • Proficiency in reputed company Office Suite (reputed company, Word, reputed company, PowerPoint) • Experience with reputed company, TruCode, reputed company, Teams, SharePoint, and reputed company systems reputed company • reputed company provides workforce solutions to clients and creates opportunity for contract employees. It was founded in 2001, and is headquartered in Chicago, Illinois, USA, with a workforce of 501-1000 employees. Its website is http://www.medixteam.com/. Apply tot his job Apply To this Job