NICU Inpatient Coding Auditor, RN (CIC/CCS)

ProgenyHealth, LLC; United States; Remote; USD 80,000 - 100,000; Full time

Benefits offered by this job

Paid Time Off

Paid Parental Leave

Medical, Dental, Vision benefits

401K with company match

Short- and Long-Term Disability

Group Life Insurance

Tuition reimbursement

Professional development opportunities

Business Casual work environment

Job summary

ProgenyHealth is seeking a Clinical RN Chart Reviewer to conduct clinical reviews of medical records, validate coding accuracy, and assess medical necessity. You will report to the Payment Assurance Manager and support improvements aligning with our mission.

The role requires certified coding expertise, with a strong understanding of DRG validation, medical necessity, and regulatory guidelines. NICU/maternity inpatient claims experience is preferred.

Qualifications

• RN licensed to practice in the United States.
• 2+ years experience with inpatient claims, preferably NICU and maternity.
• Inpatient Coding Certification CCS or CIC; must obtain CIC/CCS within 6 months if not yet certified.
• Solid understanding of MS-DRG, AP-DRG and APR-DRG payment systems.
• Experience with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG; knowledge of medical claims billing/payment systems.
• Adherence to official coding guidelines, coding clinic determinations, CMS and other regulatory guidelines.
• Expert coding knowledge in DRG, ICD-10, CPT, HCPCS codes.
• Experience with appeals is strongly preferred.
• Excellent oral and written communication; strong interpersonal skills.

Responsibilities

• Audit and analyze NICU claims per ICD-10 coding principles and clinical guidelines.
• Analyze claims data to optimize reimbursement and ensure codes/docs support services.
• Ensure compliance with ethical coding standards and regulatory requirements.
• Perform clinical reviews of medical records to validate coding accuracy and medical necessity.
• Utilize Clinical Review Tools and EMR Systems.
• Research reimbursement regulations to support audit findings.
• Develop claims audit process documentation (workflows, policies, SOPs).
• Detect discrepancies in provider billing and recommend adjustments for proper reimbursement.

Skills

RN

Clinical review

Attention to detail

Communication

Teamwork

Independent work

Problem solving

Education

Registered Nurse license

Inpatient coding certification (CCS or CIC)

Tools

EMR systems

Clinical Review Tools

Microsoft Office

Job description

ProgenyHealth is seeking a Clinical RN Chart Reviewer to conduct clinical reviews of medical records, validate coding accuracy, and assess medical necessity. You will report to the Payment Assurance Manager and support improvements aligning with our mission.

The role requires certified coding expertise, with a strong understanding of DRG validation, medical necessity, and regulatory guidelines. NICU/maternity inpatient claims experience is preferred.