NICU Inpatient Coding RN | CIC/CCS Certified Auditor

ProgenyHealth, LLC; Harmonville (PA); On-site; USD 70,000 - 90,000; 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, LLC is seeking a Clinical RN Chart Reviewer to perform clinical reviews of medical records and documentation, validating coding accuracy, medical necessity, and the appropriateness of treatment settings. You will report to the Payment Assurance Manager and support a culture of continuous improvement aligned with our mission.

The role requires certified coding expertise and a strong understanding of DRG validation, medical necessity, and regulatory guidelines.

Qualifications

• RN licensed to practice
• 2+ years inpatient claims experience, preferably NICU and maternity
• CCS or CIC certification; if not, obtain within 6 months of hire
• Solid understanding of MS-DRG, AP-DRG and APR-DRG payment systems
• Experience with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG coding and reimbursement guidelines
• Adherence to official coding guidelines and CMS regulations

Responsibilities

• Audits and analyzes NICU claims according to ICD-10 coding principles and clinical guidelines.
• Analyzes claims data to optimize reimbursement with accurate codes and documentation.
• Ensures compliance with ethical coding standards and regulatory requirements.
• Performs clinical reviews of medical records to validate coding accuracy and medical necessity.
• Utilizes Clinical Review Tools and EMR systems.
• Researches reimbursement regulations to support audit findings.
• Develops claims audit process documentation including SOPs and workflows.
• Detects discrepancies in provider billing and recommends adjustments for proper reimbursement.

Skills

Excellent communication

Interpersonal skills

Independent work

Analytical thinking

Education

Registered Nurse (RN) license

Inpatient coding certification (CCS or CIC)

Tools

Microsoft Word

Microsoft Excel

Microsoft Access

Job description

ProgenyHealth, LLC is seeking a Clinical RN Chart Reviewer to perform clinical reviews of medical records and documentation, validating coding accuracy, medical necessity, and the appropriateness of treatment settings. You will report to the Payment Assurance Manager and support a culture of continuous improvement aligned with our mission.

The role requires certified coding expertise and a strong understanding of DRG validation, medical necessity, and regulatory guidelines.