DRG/Clinical Validation Auditor RN

IntelliResume; Minnesota; On-site; USD 34,000 - 61,000; Full time

Benefits offered by this job

Paid Time Off

Medical Plan options

401(k) Savings Plan

Education Reimbursement

Employee Discounts

Job summary

IntelliResume is seeking a Clinical DRG RN Auditor to leverage expertise in MS-DRG and APR-DRG coding methodologies. The role involves auditing inpatient claims for accuracy and identifying overpayments. Ideal candidates will possess strong analytical skills and contribute to improving health outcomes.

This full-time position offers pay between $34.23 and $61.15 per hour, along with a sign-on bonus of $10,000 for external applicants and comprehensive benefits including medical and dental plans.

Qualifications

• 3+ years of MS DRG/APR DRG coding experience in a hospital environment.
• 2+ years of ICD-10-CM coding experience.
• 2+ years of ICD-10-PCS coding experience.
• Unrestricted RN (Registered Nurse) license required.
• CCS/CIC certification or willingness to obtain within 6 months of hire.

Responsibilities

• Conduct MS-DRG and APR-DRG coding reviews to verify accuracy of DRG assignment.
• Utilize expert knowledge to identify ICD-10-CM/PCS code assignments.
• Perform clinical coding reviews to ensure accuracy of medical coding.

Skills

MS-DRG coding

APR-DRG coding

ICD-10-CM coding

ICD-10-PCS coding

Analytical skills

Attention to detail

Education

Associate's Degree or higher

Job description

About This Role

As a Clinical DRG RN Auditor at UnitedHealth Group, you will leverage your expertise in MS-DRG and APR-DRG coding methodologies to audit inpatient claims, ensuring accuracy and identifying overpayments. This role is ideal for those with strong analytical skills and a commitment to improving health outcomes.

Highlights

• Pay: $34.23 - $61.15 per hour
• Location: Plymouth, MN
• Schedule: Full Time, Day shift
• Sign-On Bonus: $10,000 for external applicants

What You'll Do

• Conduct MS-DRG and APR-DRG coding reviews to verify accuracy of DRG assignment and reimbursement.
• Utilize expert knowledge to identify ICD-10-CM/PCS code assignments and appropriate code sequencing.
• Apply current ICD-10 Official Coding Guidelines and AHA Coding Clinic citations.
• Perform clinical coding reviews to ensure accuracy of medical coding.
• Write clear, accurate rationales in support of findings using coding guidelines.
• Utilize proprietary workflow systems and encoder tools to make audit determinations.
• Demonstrate knowledge of and compliance with coding guideline changes and reimbursement trends.
• Maintain and manage daily case review assignments with a focus on quality.
• Provide clinical support and expertise in investigative and analytical areas.
• Work in a high-volume production environment that is matrix driven.

Requirements

• Education: Associate's Degree (or higher) required
• Experience:
  • 3+ years of MS DRG/APR DRG coding experience in a hospital environment
  • 2+ years of ICD-10-CM coding experience
  • 2+ years of ICD-10-PCS coding experience
• Licenses & Certifications:
  • Unrestricted RN (Registered Nurse) license required
  • CCS/CIC certification or willingness to obtain within 6 months of hire

Benefits

• Paid Time Off plus 8 Paid Holidays
• Medical Plan options with Health Spending Account or Health Saving Account
• Dental, Vision, Life & AD&D Insurance, Short-term and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, etc.)

About UnitedHealth Group

UnitedHealth Group is a leading healthcare provider committed to delivering exceptional patient care. They focus on improving health outcomes through technology and comprehensive services, ensuring that millions of people can live healthier lives. Their culture emphasizes inclusion, career development, and community impact.