DRG Coding & Clinical Validation Analyst I–III

Excellus BCBS; Town of De Witt (NY); On-site; USD 65,346 - 142,322; Full time

Benefits offered by this job

Health and dental insurance

Retirement plan

Paid time off

Job summary

A healthcare insurance provider in New York seeks a Payment Integrity DRG Coding & Clinical Validation Analyst responsible for auditing inpatient claims and ensuring accurate documentation for coding. Candidates should have a strong background in ICD-10 coding, claims auditing, and possess relevant certifications. This role spans three levels, each requiring increasing experience and expertise in DRG payment systems and leadership capabilities.

Qualifications

• Three years of claims auditing experience in DRG coding for hospital settings.
• Experience with ICD-10CM and MS-DRG payment systems.
• Maintained coding certification (RHIA, RHIT, CCS, or CIC).

Responsibilities

• Analyze and audit acute inpatient claims based on coding principles.
• Perform complex audits with minimal direction.
• Provide expertise in developing audit data criteria.

Skills

ICD-10 coding

Analytical skills

Attention to detail

Leadership

Education

Associate or bachelor's degree in Health Information Management or Nursing

Tools

Claims processing systems

Auditing tools

Job description

A healthcare insurance provider in New York seeks a Payment Integrity DRG Coding & Clinical Validation Analyst responsible for auditing inpatient claims and ensuring accurate documentation for coding. Candidates should have a strong background in ICD-10 coding, claims auditing, and possess relevant certifications. This role spans three levels, each requiring increasing experience and expertise in DRG payment systems and leadership capabilities.