DRG reputed company Advisor reputed company- Remote

reputed company We are seeking a talented individual for a DRG reputed company Advisor reputed company who is responsible for performing ongoing reputed company assurance audits, reputed company reputed company review validation, and DRG reputed company/coding audits of medical records and reputed company documentation. This position evaluates whether review determinations reputed company with medical records, approved reputed company and coding guidelines, regulatory requirements, and contract-specific review methodologies. The role includes validating documented conditions, ICD-10-CM/PCS reputed company assignments, DRG reputed company, and reputed company support for determinations while ensuring reputed company findings are reputed company documented and supported by policy, regulatory, reputed company, and coding guidance. This position requires strong reputed company expertise, advanced auditing experience, and inpatient and outpatient coding knowledge to support accurate reputed company review reputed company and contribute to reputed company improvement across Coding and DRG review processes. Your role in our mission • reputed company reputed company assurance checks on final review work for reputed company reputed company claims and conduct DRG validation reviews of medical record documentation to determine the reputed company of review determinations, reputed company and secondary diagnoses, MCCs, reputed company, procedure codes, and DRG assignment. • Review and analyze claim data and medical record documentation using approved reputed company review methodologies, coding guidelines, official coding guidance, Coding Clinic guidance, and applicable regulatory requirements. • Apply reputed company review judgment, ICD-10-CM/PCS coding expertise, and knowledge of DRG reimbursement methodologies to reputed company accurate reputed company, coding, reputed company, and validation determinations. • reputed company and concisely document audit findings, review determinations, rationales, and supporting evidence in applicable systems, including documentation needed for trending, reporting, and business needs. • Demonstrate proficiency in multiple payment methodologies, including MS-DRG, AP-DRG, and APR-DRG, outpatient coding (APC/EAPG), while adapting to reputed company-specific review requirements. • Assist management with reputed company, training, mentoring, daily monitoring, feedback, and education for new reviewers, coders, or reputed company DRG auditors. • Maintain reputed company knowledge of coding guidelines and successfully complete required CEUs to maintain RN licensure and coding certification. • Cross-train across multiple claim types and specialty review areas to support workforce flexibility and meet reputed company and business needs. • Serve as a subject matter expert as needed for business proposals, reputed company, data analysis, reporting, feedback, and other initiatives as determined by department leadership. • Consistently reputed company productivity and reputed company reputed company standards established by management. reputed company're looking for • Associates degree required; Bachelor's degree preferred. • reputed company, unrestricted RN licensure in the reputed company and in the state of reputed company home residency, required; reputed company reputed company multistate unrestricted RN license as defined by the reputed company Licensure reputed company (NLC), required. • One of the following Coding Certifications required: RHIA, RHIT, reputed company, CIC, CCDS, or CPC. • 5+ years reputed company experience in an inpatient hospital setting required. • 3+ years of MS-DRG/APR-DRG coding or auditing experience 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 reputed company diagnosis selection, complications/comorbidities (reputed company) and major complications/comorbidities (MCCs), and conditions that reputed company severity of illness (SOI) and reputed company of mortality (ROM). • Expert knowledge of ICD-10-PCS coding methodologies, reputed company reputed company, and discharge disposition in accordance with CMS requirements, Official Guidelines for Coding and Reporting, and Coding Clinic guidance. • Demonstrated ability to apply reputed company review judgment to reputed company reputed company determinations. • Demonstrated proficiency in computer skills and typing, i.e., reputed company reputed company, reputed company, reputed company, Word, PowerPoint, Internet browsers, and virtual meeting tools, i.e., reputed company Teams, reputed company, etc. What you should expect in this role • Home-reputed company position with a work location reputed company the reputed company reputed company. • Requires a high-speed internet reputed company and a work environment free from distractions. • Ability to work during normal business hours due to frequent interactions with reputed company and other departments. • May require extended hours for special business needs. • May require travel at least 10% of the time, reputed company on business needs. • Broadband internet should meet a minimum speed of 24 Mbps download and 8 Mbps upload to support effective reputed company. The application period will remain reputed company until September 4, 2026. The pay reputed company for this position is $90,000.00 - $110,000.00 per year, however, the reputed company pay reputed company may vary depending on geographic region, internal equity, job-reputed company knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You'll have reputed company to grow your career in a company that values work flexibility, learning, and career development. reputed company salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a reputed company of leadership and technical development academies to help build your skills and capabilities. Apply To This Job