DRG Revenue Integrity Auditor ($12k Sign-on Bonus available!)

Rymer, Echols, Slay & Nelson-Archer, P.C.; United States; Remote; USD 70,000 - 90,000; Full time

Job summary

A leading company seeks a DRG Revenue Integrity Auditor to perform vital audits and coding validation in healthcare contexts. Applicants should have significant experience in acute care settings, highlighting analytical skills and the ability to work independently. In this full-time role, you can enjoy a predictable remote schedule, career growth, and comprehensive benefits.

Benefits

Remote predictable, full-time schedule

Career growth opportunities

Medical, Dental, Vision coverage

401K with match

Long-term disability insurance

Life insurance

Paid time off

Allowance for CME or license renewal

Qualifications

• Five or more years in acute care or as a DRG Auditor.
• Training or experience as a CDI/Coding auditor preferred, but not mandatory.

Responsibilities

• Perform DRG validation and quality audits on Inpatient charts.
• Maintain quality of reviews and support coding guidelines adherence.
• Conduct chart reviews and assist with data analysis and reporting.

Skills

Analytical skills

Attention to detail

Communication skills

Team player

Tools

Electronic medical record systems

MS Word

MS Excel

MS Outlook

MS Teams

Job description

The DRG Revenue Integrity Auditor (DRG - A) performs Diagnostic Related Group (DRG) validation and quality audits on Inpatient charts. The DRG - A will perform chart reviews and will ensure that all reviewed charts capture the patient’s true clinical picture from the codes assigned by the facility’s coders in compliance with federal laws. The DRG - A will utilize International Classification of Diseases - Clinical Modification (CM) and Procedure Coding System (PCS) Terminology to ensure accurate coding. Responsible for validating proper sequencing and accuracy of ICD-10-CM/PCS codes, POA assignments, severity of illness (SOI), risk of mortality (ROM), Hierarchical Condition Category (HCC) capture CMI and other coding factors. Usage of most current Clinical Criteria, MCG, InterQual, payers’ Clinical Policy Bulletins, CMS Guidelines, NCDs and/or LCDs.

Important Duties and Responsibilities:

• Adherence to all coding guidelines and CDI best practices, as endorsed by ACDIS and AHIMA, to determine correct coding that is clinically supported
• Analyze records for potential query opportunities and appropriate code assignment and code sequencing
  Maintain quality of reviews and making sure the true clinical picture is captured, along with ensuring chart review productivity
• Staying up to date with official coding guidelines, coding clinics and clinical criteria
• Available to provide training to other new hires, if required, along with supporting development of training materials, as well as clinical, coding and CDI policies
• Assisting with project data analysis, reporting, and feedback both internally and to clients
  In all situations, protecting the privacy and confidentiality of patient health and client information, and follows the Standards of Ethical Coding as set forth by AHIMA and adheres to official coding guidelines and compliance practices, standards, and procedures
• Conduct chart reviews as assigned, meeting the productivity standards as set forth for each project or record type
• Communicates with coworkers in an open and respectful manner that promotes teamwork and knowledge sharing
• When interacting with clients, always conducts themselves in a professional manner, exhibiting excellent relationship, work performance and communication skill so as to support the company and its business interests
• Maintenance of professional credentials and knowledge of CDI, coding, reimbursement, and compliance issues through continuing education
• Other duties and responsibilities, as assigned
  

Work Experience:

• Five or more years working in an acute care setting or a third-party vendor as a DRG Auditor or Clinical Documentation Specialist (CDS).
• Prior experience of working as a CDI/Coding auditor is preferred but NOT a requirement.
  

Knowledge, Skills & Abilities:

• Experience with telecommuting and electronic medical record systems required
• Good computer skills and familiarity with commonly used work apps, such as MS Word, MS Excel, MS Outlook, Teams, etc.
• Strong analytical skills
• Works well with numbers, using basic math skills
• Strong team player
• Ability to work with multiple and diverse clients and projects
• Ability to switch between multiple clients throughout the day and week
• Ability to work with minimal supervision
• Ability to maintain and access multiple files

We Offer:

• Quality of life with a remote predictable, full-time schedule
  Exempt/Salaried positions
• Opportunities for career growth within the organization
• Medical, Dental, Vision coverage, 401K with match
• Long-term disability insurance, life insurance and more
• Holidays Time and ample paid time off
• Allowance for CME and/or license renewal