DRG Clinical Auditor — ICD-10 Coding & Compliance

Ultipro; Fort Worth (TX); On-site; USD 65,000 - 90,000; Full time

Job summary

CERIS, a division of CorVel Corporation, is seeking a DRG Clinical Auditor to perform DRG validation reviews of medical records and documentation to determine correct DRG/coding per review methodologies. You will apply ICD-10-CM/PCS guidelines, assess medical necessity, and support decisions with clear documentation.

Ideal candidates have RN/LVN licensure, CCS or CIC certification, DRG auditing experience, and knowledge of Medicare/Medicaid payer rules.

Qualifications

• RN or LVN license in the state of employment.
• CCS or CIC certification with DRG auditing experience in ICD-10-CM, ICD-10-PCS.
• Experience in the OR, ICU, or ER as an RN is 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 codes, PCS and DRG coding, payer rules incl. Medicare/Medicaid.
• 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

Written and verbal communication

Attention to detail

Critical thinking

Teamwork

Independent work

Multi-tasking

Relationship building

Works in fast-paced environment

Typing

Education

LVN or RN license

CCS or CIC certification

RN experience in OR/ICU/ER

Tools

Microsoft Office

Job description

CERIS, a division of CorVel Corporation, is seeking a DRG Clinical Auditor to perform DRG validation reviews of medical records and documentation to determine correct DRG/coding per review methodologies. You will apply ICD-10-CM/PCS guidelines, assess medical necessity, and support decisions with clear documentation.

Ideal candidates have RN/LVN licensure, CCS or CIC certification, DRG auditing experience, and knowledge of Medicare/Medicaid payer rules.