DRG Claims Auditor, Recoveries

Mass General Brigham; Somerville (MA); Remote; USD 60,000 - 90,000; Full time

Job summary

An established industry player in healthcare services is seeking a detail-oriented coding expert to join their team. This remote opportunity allows you to engage in meaningful work that contributes to improving patient care. You will perform DRG validation and quality audits on claims, ensuring compliance with medical policies. Candidates should have a strong background in coding, with certifications such as CIC or CPC, and experience in claims auditing. Join a supportive environment focused on quality and integrity, and take the next step in your career with ample opportunities for professional growth.

Qualifications

• 3-5 years of experience in claims auditing or recovery auditing.
• Certification as a Certified Inpatient Coder (CIC) or similar is required.

Responsibilities

• Perform DRG validation and quality audits on claims.
• Utilize clinical knowledge to assign ICD-10-CM/PCS codes accurately.

Skills

ICD-10-CM/PCS coding

DRG validation

Claims auditing

Microsoft Suite

Excel

Education

Associate's degree

Bachelor's degree

Job description

Employer Industry: Healthcare Services

Why consider this job opportunity:
- Remote work opportunity available from most U.S. states
- Competitive salary with a standard 40-hour work week
- Opportunity for career advancement and professional growth within the organization
- Work in a supportive environment focused on quality and integrity
- Engage in meaningful work that contributes to improving patient care and outcomes

What to Expect (Job Responsibilities):
- Perform DRG validation and quality audits on claims, ensuring compliance with medical and reimbursement policies
- Utilize clinical knowledge to accurately assign ICD-10-CM/PCS codes and maintain adherence to CMS requirements
- Analyze facility and professional claims, providing insights based on established guidelines and decision-making processes
- Identify billing trends and potential recovery areas while enhancing audit methodologies
- Maintain daily case review assignments with an emphasis on quality in a high-volume production environment

What is Required (Qualifications):
- Associate’s degree or equivalent combination of training and experience, plus 3-5 years of related experience; Bachelor’s degree preferred
- Certification as a Certified Inpatient Coder (CIC), Certified Professional Coder (CPC), or Certified Coding Specialist (CCS) required
- Minimum of 5 years of experience in a DRG validation role performing claims auditing or recovery auditing
- Thorough knowledge of ICD-10, CPT, HCPCS, and Revenue Billing Codes
- Strong Microsoft Suite and Excel skills required

How to Stand Out (Preferred Qualifications):
- Nursing license is preferred
- Excellent project management skills
- Familiarity with the regulatory environment for financial services
- Strong interpersonal skills and ability to influence at all organizational levels
- Ability to communicate complex topics effectively in various forums

#HealthcareServices #RemoteWork #CareerGrowth #CodingExpertise #QualityAuditing #PatientCare

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