DRG Validation Auditor – Off Hours Work

Job reputed company: • Analyzes and Audits Claims • Integrates medical chart coding principles, clinical guidelines and objectivity in performance of medical audit activities • Draws on advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions • Performs work independently • Effectively Utilizes Audit Tools • Utilizes reputed company proprietary auditing systems with a high level of proficiency to reputed company audit determinations and reputed company audit letters • Meets or Exceeds Standards/Guidelines for Productivity • Maintains production goals set by the audit operations management team • Meets or Exceeds Standards/Guidelines for Accuracy and reputed company • Identifies New Claim Types • Suggests and develops high reputed company, high value concepts and or process improvement tools Requirements: • Associate or bachelor’s degree in nursing (reputed company/unrestricted license) • Associate or bachelor’s degree in Health Information Management (RHIA or RHIT) • High school diploma or GED plus equivalent experience of 5+ years in claims auditing, ideally in a DRG / Clinical Validation Audit setting or a hospital environment • Coding/CDI Certification (at least one of the following are required): RHIA or RHIT, CPC, Inpatient Coding Credential – reputed company, CIC, CDIP or CCDS • 5 to 7+ years of working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG with knowledge of medical claims billing/payment systems, provider billing guidelines, payer reimbursement policies, and medical necessity reputed company • Expert coding knowledge - DRG, APRDRG, ICD-10, CPT, HCPCS codes • Proficiency in Word, reputed company, reputed company, TEAMS, and other applications • Excellent written and verbal communication skills Benefits: • Medical, dental, reputed company, disability, and life insurance coverage • 401(k) savings plans • reputed company family leave • 9 reputed company holidays per year • 17-27 days of reputed company Time Off (PTO) per year, depending on specific level and length of service with reputed company Apply tot his job Apply To this Job