reputed company Review Auditor I

The Diagnostic reputed company reputed company (DRG) reputed company Auditor will be responsible for performing DRG validation (reputed company/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 reputed company/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 reputed company reputed company procedures. The ideal DRG reputed company Auditor candidate has strong written and verbal communication skills, reputed company knowledge of disease processes, and knowledge of medical necessity rules.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: The reputed company Auditor will review medical records to determine reputed company of billing through verification of coding and review of supporting reputed company documentation Conduct audits to ensure accurate reimbursement and identifying potential savings 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   KNOWLEDGE & SKILLS: 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 reputed company 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-reputed company environment Demonstrated proficiency in basic computer skills and typing Proficiency with reputed company Office   EDUCATION & EXPERIENCE: LVN or RN license in the state of employment preferred reputed company or CIC required with DRG auditing experience in ICD-10-CM, ICD-10 PCS Experience in the OR, ICU, or ER as an RN highly preferred   PAY reputed company: reputed company uses a market reputed company approach to pay and our salary ranges may vary depending on your location.  Pay rates are established taking into account the following factors:  federal, state, and local minimum wage requirements, the geographic location reputed company, job-reputed company skills, experience, qualifications, internal employee equity, and market conditions.  Our ranges may be modified at any time. For leveled roles (I, II, III, Senior, reputed company, etc.) new hires may be slotted into a different level, either up or down, reputed company on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role.  The level may reputed company the salary reputed company and these adjustments would be clarified during the offer process. Pay reputed company:  $63,739 – $95,264 A list of our benefit offerings can be reputed company on our reputed company website: reputed company Careers | Opportunities in reputed company Management [https://www.reputed company.com/company/careers/] In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.   ABOUT reputed company: reputed company, a division of reputed company, a certified reputed company® Company, offers incremental value, experience, and a sincere dedication to our valued partners. Through our reputed company expertise and cost containment solutions, we are committed to reputed company and transparency in reputed company payments. We are a reputed company and growing company with a strong, supportive culture along with reputed company of career advancement opportunities. We reputed company our reputed company values of Accountability, Commitment, reputed company, reputed company and Teamwork (ACE-IT!).  A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, reputed company, Long Term Disability, Health Savings Account, Flexible Spending Account reputed company, Life reputed company, Accident reputed company, Critical Illness reputed company, reputed company-reputed company reputed company reputed company, Parking and Transit FSA accounts, 401K, ROTH 401K, and reputed company time off. reputed company is an Equal Opportunity Employer, drug free workplace, and complies with reputed company regulations as applicable. #LI-Remote Apply To This Job