Clinical Review Auditor

CorVel Corporation; Fort Worth (TX); Remote; USD 60,000 - 80,000; Full time

Job summary

CorVel Corporation is seeking a DRG Coder/Clinical Auditor in Fort Worth, Texas. This role involves performing DRG validation reviews of medical records, ensuring accurate coding, and compliance with regulations. Candidates must have at least 1 year of auditing experience and a relevant coding certification, with opportunities for career advancement within a supportive environment.

Benefits

Comprehensive benefits package

401K and ROTH 401K

Paid time off

Qualifications

• Minimum of 1 year recent DRG auditing experience in a hospital or health plan.
• Extensive hands-on ICD-10 CM / PCS experience.
• Proficient in Medicare and CMS guidelines.

Responsibilities

• Review medical records to determine accuracy of billing and coding.
• Conduct audits to ensure accurate charge capture.
• Check for physician's notes supporting DRGs assigned.

Skills

Problem Solving

Communication

Critical Thinking

Education

National Coding Certification

Tools

Microsoft Office Suite

Job description

TX - Fort Worth
5128 Apache Plume Rd
Suite 400
Fort Worth, TX 76109, USA

TX - Fort Worth
5128 Apache Plume Rd
Suite 400
Fort Worth, TX 76109, USA

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
• 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.

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.

Qualifications

Skills

Behaviors

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Motivations

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Education

Experience

Licenses & Certifications

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.