DRG Auditor

National Association of Mutual Insurance Companies; Deutschland; Remote; EUR 70.000 - 90.000; Vollzeit

Zusammenfassung

A leading healthcare staffing firm is seeking a DRG Validation Auditor to work 100% remote. Candidates must have 5-7 years of experience with ICD-9/10CM and a strong understanding of MS-DRG payment systems. Responsibilities include auditing inpatient medical records and ensuring accuracy in coding. A background as an inpatient RN with coding certification is required.

Qualifikationen

• 5-7+ years working with ICD-9/10CM, MS-DRG, AP-DRG, APR-DRG.
• Broad knowledge of medical claims billing/payment systems.
• Must be an inpatient RN with coding certification or related degree.

Aufgaben

• Audit inpatient medical records for coding and DRG assignment accuracy.
• Integrate medical coding principles in audit activities.
• Utilize proprietary auditing systems to make determinations.

Kenntnisse

ICD-9/10CM expertise

DRG payment systems knowledge

Clinical documentation expertise

Ausbildung

Registered Nurse RN with coding/clinical documentation certification

Degree in RHIM, RHIA, RHIT with medical coding degree or CCS

Jobbeschreibung

Insight Global is seeking a DRG Validation Auditor for one of our clients to sit 100% remote. This person should have an extensive background in either facility-based nursing, clinical documentation, and/or inpatient coding and has a high level of understanding of reimbursement guidelines, specifically an understanding of the MS-DRG, AP-DRG, and APR-DRG payment systems.

This position is responsible for auditing inpatient medical records and generating high-quality recoverable claims for the benefit of our client and their clients. They are responsible for performing clinical reviews of medical records and other documentation to evaluate issues of coding and DRG assignment accuracy. Below are the key responsibilities for this role:

1. Integrates medical chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities. Draws on advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions. Performs work independently.
2. Utilizes the client's proprietary auditing systems with a high level of proficiency to make audit determinations and generate audit letters.
3. Maintains production goals set by the audit operations management team.
4. Achieves the expected level of accuracy and quality set by the audit for the auditing concept, for valid claim identification and documentation (letter writing).
5. Identifies potential claims outside of the concept where additional recoveries may be available. Suggests and develops high-quality, high-value concepts and/or process improvements, tools, etc.

Must Haves

• 5-7+ years of working with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG with a broad knowledge of medical claims billing/payment systems, provider billing guidelines, payer reimbursement policies, medical necessity criteria, and coding terminology.
• Expert coding knowledge (DRG & ICD-10).
• Registered Nurse RN (must be inpatient) WITH coding/clinical documentation certification (2 years in clinical documentation).
• OR
• Degree in RHIM, RHIA, RHIT with medical coding degree or just CCS is acceptable with strong clinical knowledge.