DRG Coding/Clinical RN Auditor

UnitedHealth Group; Minnesota; On-site; USD 100,289,000 - 180,521,000; Full time

Benefits offered by this job

Paid Time Off with first pay period

Health plan options with HSA/HDHP

Dental, Vision, Life & AD&D insurance

401(k) Savings Plan

Education reimbursement

Employee Discounts

Employee Assistance Program

Employee referral bonus

Job summary

UnitedHealth Group is seeking a Clinical DRG RN auditor in Plymouth, MN to verify DRG assignments and reimbursement. You will apply MS-DRG and APR-DRG knowledge, ICD-10-CM/PCS coding, and official guidelines to ensure accurate medical coding and coding rationales.

The role requires an RN license, an associate degree, and 2+ years in DRG coding within a hospital setting, with a daytime full-time schedule and competitive pay in the Plymouth area.

Qualifications

• Associate's degree required in nursing or a related field.
• 2+ years MS-DRG/APR-DRG coding experience in a hospital setting.
• 2+ years ICD-10-CM coding experience and ICD-10-PCS coding experience.

Responsibilities

• Conduct MS-DRG and APR-DRG coding reviews to verify DRG assignment and reimbursement.
• Identify ICD-10-CM/PCS code assignments and sequencing.
• Apply ICD-10 guidelines and coding clinic citations.
• Maintain high-quality daily case reviews and provide clinical support.
• Write clear rationales supporting findings.

Skills

MS-DRG coding

APR-DRG coding

ICD-10-CM coding

ICD-10-PCS coding

RN license

Education

Associate degree

Tools

Workflow systems

Encoder tool

Job description

About This Role

In this position as a Clinical DRG RN auditor, you will apply your expert knowledge of the MS-DRG and APR-DRG coding/reimbursement methodology systems to audit inpatient claims. This role is ideal for those with strong analytical skills and a background in coding and reimbursement methodologies.

Highlights

• Pay: $35 - $63/hour
• Location: Plymouth, MN
• Schedule: Full Time, Day shift
• Residency: No residency required

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 assignment and appropriate code sequencing.
• Apply current ICD-10 Official Coding Guidelines and AHA Coding Clinic citations.
• Perform clinical coding review to ensure accuracy of medical coding.
• Utilize solid command of anatomy and physiology for ICD-10-PCS code assignment.
• Write clear, accurate, and concise rationales in support of findings.
• Utilize proprietary workflow systems and encoder tool efficiently.
• Demonstrate knowledge of and compliance with changes to coding guidelines.
• Maintain and manage daily case review assignments with a high emphasis on quality.
• Provide clinical support and expertise to other investigative and analytical areas.

Requirements

Education

• Associate's degree required

Experience

• 2+ 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 or willing to obtain certification within 6 months of hire

Benefits

• Paid Time Off which accrues with your first pay period 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, LTC Insurance, etc.)

About UnitedHealth Group

UnitedHealth Group is a leading healthcare provider committed to delivering exceptional patient care. They focus on improving health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to live healthier lives.