DRG Clinical Auditor I: ICD-10 Coding & Compliance

CorVel Corporation; Fort Worth, Northern (TX, KY); Hybrid; USD 65,000 - 95,000; Full time

Benefits offered by this job

Medical (HDHP) w/ Pharmacy

Dental

Vision

Life Insurance

401K

Paid time off

Job summary

CERIS, a division of CorVel Corporation, is seeking a DRG Clinical Auditor in Fort Worth, TX to perform DRG validation and coding reviews of medical records. You will determine correct DRG/coding per review methodologies and support clinical/policy/regulatory decisions, using ICD-10-CM/PCS guidelines and knowledge of pharmacology and disease management.

The role requires strong written and verbal communication, attention to detail, and the ability to work independently or with a team in a

Qualifications

• LVN or RN license in the state of employment preferred.
• CCS or CIC required with DRG auditing experience in ICD-10-CM, ICD-10 PCS.
• Experience in the OR, ICU, or ER as an RN highly preferred.

Responsibilities

• Review medical records to determine accuracy of billing through verification of coding and review of supporting clinical documentation.
• Conduct audits to ensure accurate reimbursement and identifying potential savings.
• Demonstrated knowledge of ICD-10-CM, PCS and DRG coding, understanding of payer rules and regulations.
• Understand and comply with all internal and external policies.
• Working knowledge of HIPAA Privacy and Security Rules.
• Assist Quality Control team and medical director with appeals, rebuttals, etc.
• Notify leadership of any issues or concerns in a timely manner.
• Additional duties as assigned.

Skills

Medicare guidelines

CMS guidelines

ICD-10 coding

Documentation skills

Verbal & written communication

Attention to detail

Critical thinking

HIPAA compliance

Team collaboration

MS Office

Education

LVN or RN license

CCS or CIC certification

OR/ICU/ER RN experience

Tools

Microsoft Office

Job description

CERIS, a division of CorVel Corporation, is seeking a DRG Clinical Auditor in Fort Worth, TX to perform DRG validation and coding reviews of medical records. You will determine correct DRG/coding per review methodologies and support clinical/policy/regulatory decisions, using ICD-10-CM/PCS guidelines and knowledge of pharmacology and disease management.

The role requires strong written and verbal communication, attention to detail, and the ability to work independently or with a team in a