Clinical Review Auditor

CorVel Corporation; Fort Worth (TX); Remote; USD 68,000 - 105,000; Full time

Job summary

CorVel Corporation is seeking a Clinical Review Auditor to perform DRG validation and auditing tasks remotely. The ideal candidate will have strong attention to detail and experience with coding guidelines. This position offers competitive salary and benefits as part of a stable and supportive company culture.

Benefits

Comprehensive benefits package

401K plan

Paid time off

Qualifications

• Minimum 1 year of DRG auditing experience.
• Extensive hands-on experience with ICD-10 CM/PCS.
• Proficient in Medicare and CMS guidelines.

Responsibilities

• Review medical records for accurate coding and documentation.
• Conduct audits to enhance reimbursement and identify savings.
• Check physician's notes for DRG support.

Skills

Attention to detail

Problem solving

Critical thinking

Effective communication

Education

National Coding Certification (AHIMA or AAPC)

RN license (preferred)

Tools

ICD-10-CM

ICD-10-PCS

Microsoft Office Suite

Job description

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Join to apply for the Clinical Review Auditor role at CorVel Corporation

CERIS in Fort Worth, Texas is seeking a DRG Coder/Clinical Auditor. The Diagnostic Related Groups (DRG) Clinical Auditor will be responsible for performing DRG validation (clinical/coding) reviews of medical records and/or other documentation to determine correct DRG/coding that is clinically supported as defined by review methodologies specific to the contract for which review services are being provided. This involves completing medical records review, accurately documenting findings and non-findings and providing clinical/policy/regulatory support for the determination. Experience using, ICD-10-CM & PCS coding guidelines, the ability to understand modern pharmacology, disease management and clinical intervention procedures.

This is a remote role.

Job Duties And Responsibilities

• The Clinical Auditor will look at individual medical records to check for missing documentation;
• The Clinical Auditor will check for physician's notes supporting the DRGs assigned.
• Reviewing medical records to determine accuracy of billing through verification of coding and supporting clinical documentation.
• Conducting audits to ensure accurate charge capture, enhancing 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 Medicaid with the ability to work independently with minimal supervision and demonstrate initiative.
• Able to clearly and accurately communicate findings.
  
  

Qualifications

• Required minimum of 1 year of recent DRG auditing experience in a hospital setting, or health plan. National Coding Certification required through AHIMA (preferred) or AAPC.
• RN license is preferred but not required
• Extensive hands-on ICD-10 CM / PCS experience required.
• Proficient in both MS and APR DRG methodology.
• Working knowledge of application of current Official Coding Guidelines and Coding Clinic citations
• Solid knowledge and understanding of clinical criteria documentation requirements used to successfully substantiate code assignments.
• Proficient in Medicare and CMS guidelines
• Extreme attention to detail.
• Must possess problem solving, critical thinking skills.
• Minimal typing experience.
• Effective and professional communication skills, both verbal and written.
• Ability to think and work independently, while working in an overall team environment.
• Ability to work in a fast paced/production environment.
• Proficient in Microsoft Office Suite.
• Other duties as assigned
  
  

Pay Range

CorVel uses a market based 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 differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.

For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.

Pay Range: $68,566 – $104,841

A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management

About CERIS

CERIS, a division of CorVel Corporation, a certified Great Place to Work Company, offers incremental value, experience, and a sincere dedication to our valued partners. Through our clinical expertise and cost containment solutions, we are committed to accuracy and transparency in healthcare payments. We are a stable and growing company with a strong, supportive culture along with plenty of career advancement opportunities. We embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).

A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.

CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Accounting/Auditing and Finance

• Industries

  Insurance

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