Clinical Review Auditor

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

Job summary

An established industry player is looking for a DRG Coder/Clinical Auditor to join their remote team. In this pivotal role, you will conduct thorough reviews of medical records to ensure accurate coding and compliance with clinical documentation standards. Your expertise in ICD-10-CM coding and clinical auditing will be essential in identifying discrepancies and supporting accurate reimbursement processes. This role offers an opportunity to work independently while contributing to a collaborative team environment, ensuring quality and integrity in healthcare payments. With a strong commitment to employee development and a comprehensive benefits package, this position is perfect for those looking to advance their careers in a supportive and dynamic setting.

Benefits

Medical Insurance

Dental Insurance

Vision Insurance

401K

Paid Time Off

Long Term Disability

Health Savings Account

Flexible Spending Account

Life Insurance

Critical Illness Insurance

Qualifications

• Must maintain current RN licensure and have CCS or CIC certification.
• Experience in DRG auditing and knowledge of Medicare guidelines is essential.

Responsibilities

• Review medical records for accurate billing and coding verification.
• Conduct audits to ensure reimbursement accuracy and identify savings.
• Assist with Quality Control and communicate findings effectively.

Skills

ICD-10-CM Coding

Clinical Auditing

Critical Thinking

Communication Skills

Attention to Detail

Education

Associate Degree in Nursing

Registered Nurse Licensure

CCS or CIC Certification

Tools

Microsoft Office Suite

Electronic Medical Records Systems

Job description

CERIS 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 and clinically supported as defined by review methodologies specific to the type of review. 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. The ideal DRG Clinical Auditor candidate will have strong oral and written communication skills, clinical knowledge of disease process, and knowledge of medical necessity rules.

This is a remote position.

ESSENTIAL FUNCTIONS & RESPONSIBILITIES:

• The Clinical Auditor will review medical records to determine accuracy of billing through verification of coding and supporting clinical documentation.
• Conducting 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 Medicaid.
• The ability to work independently with minimal supervision and demonstrate initiative.
• Able to communicate clearly and accurately.
• Clearly understands and complies with all internal and external policies.
• Working knowledge of HIPAA Privacy and Security Rules.
• Ability to multi-task and assist with team coverage and provide support when needed.
• Ability to build relationships both internally and externally.
• Assists Quality Control team and medical director with Appeals, Rebuttals, etc.
• Demonstrated proficiency in basic computer skills and typing, i.e., Microsoft Windows, Outlook, Word, PowerPoint, Internet Explorer, etc.
• Notify manager/leadership of any issues or concerns in a timely manner.
• Additional duties as assigned by leadership.

KNOWLEDGE & SKILLS:

• Extreme attention to detail.
• Must possess critical thinking skills.
• 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 environment.
• Proficient in Microsoft Office Suite.

EDUCATION & EXPERIENCE:

• Associate degree in nursing or higher required.
• Must maintain current licensure as a registered nurse in the state of employment.
• CCS or CIC required with DRG auditing experience in ICD-10-CM, ICD-10 PCS.
• Proficient in Medicare, CMS guidelines and ICD-10 coding guidelines.
• Experience in the OR, ICU, or ER as an RN highly preferred.

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

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.

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