Medical Coder

Insight Global; Remote; USD 70,000 - 90,000; Full time

Job summary

A leading healthcare staffing agency is seeking a DRG Validation Auditor to work 100% remotely. The ideal candidate will have substantial nursing experience, coding expertise, and an understanding of reimbursement guidelines. Responsibilities include auditing inpatient medical records to ensure accurate DRG assignment and documentation, utilizing specialized auditing systems, and maintaining production goals set by management. This role is crucial for generating high-quality claims for the benefit of clients.

Qualifications

• 2+ years of experience with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG billing.
• Must be an inpatient RN with coding/clinical documentation certification.

Responsibilities

• Auditing inpatient medical records to generate claims.
• Integrating medical coding principles and clinical guidelines.
• Utilizing proprietary auditing systems effectively.

Skills

ICD-9/10CM knowledge

MS-DRG knowledge

AP-DRG knowledge

APR-DRG knowledge

Expert coding knowledge (DRG & ICD-10)

Clinical documentation

Education

Registered Nurse RN

Job description

Qualifications

• 2+ years of working with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG with a broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, medical necessity criteria, and coding terminology.
• Expert coding knowledge (DRG & ICD-10)
• Registered Nurse RN (must be inpatient) WITH coding/clinical documentation certification (2 years in clinical documentation)

Day to Day

Insight Global is seeking a DRG Validation Auditor for one of our clients to sit 100% remote. This person should have an extensive background in either facility-based nursing, clinical documentation, and/or inpatient coding and has a high level of understanding of reimbursement guidelines specifically an understanding of the MS-DRG, AP-DRG, and APR-DRG payment systems. This position is responsible for auditing inpatient medical records and generating high-quality recoverable claims for the benefit of our client and their clients. They are responsible for performing clinical reviews of medical records and other documentation to evaluate issues of coding and DRG assignment accuracy. Below are the key responsibilities for this role:

Responsibilities

• Integrates medical chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities. Draws on advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions. Performs work independently.
• Utilizes the clients proprietary auditing systems with a high level of proficiency to make audit determinations and generate audit letters.
• Maintains production goals set by the audit operations management team.
• Achieves the expected level of accuracy and quality set by the audit for the auditing concept, for valid claim identification and documentation (letter writing).
• Identifies potential claims outside of the concept where additional recoveries may be available. Suggests and develops high-quality, high-value concepts and or process improvement, tools, etc.