Nurse Inpatient Coding Auditor, CIC or CCS certified

ProgenyHealth, LLC; Town of Texas (WI); Remote; USD 60,000 - 100,000; Full time

Job summary

An established industry player in healthcare is seeking a dedicated Nurse Inpatient Coding Auditor to join their fully remote team. This role focuses on ensuring coding accuracy and compliance for neonatal intensive care unit claims, utilizing your expertise in ICD-10 and inpatient coding principles. You will collaborate with a dynamic team to enhance reimbursement processes and uphold ethical coding standards. This innovative firm is committed to improving maternal and infant health outcomes, providing a supportive environment for professional growth and development. If you are passionate about making a difference in healthcare, this opportunity is perfect for you.

Benefits

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

Qualifications

• Registered Nurse with inpatient coding certification required.
• 3+ years of experience in coding and reimbursement guidelines.

Responsibilities

• Conduct audits and analyses of NICU claims per ICD-10 coding principles.
• Perform clinical reviews of medical records for coding accuracy.

Skills

Registered Nurse

Inpatient Coding Certification (CCS or CIC)

ICD-9/10CM knowledge

MS-DRG, AP-DRG, APR-DRG systems knowledge

Excellent communication skills

Interpersonal skills

Critical thinking and problem solving

Education

Registered Nurse degree

Tools

Microsoft Office (Word, Excel, Access)

Job description

All Jobs > Nurse Inpatient Coding Auditor, CIC or CCS certified

Nurse Inpatient Coding Auditor, CIC or CCS certified
Fully Remote • TX

Full-time

Description

Company

ProgenyHealth is a leading provider of care management solutions for premature and medically complex newborns positively impacting maternal and infant health outcomes across America. Our program builds a network of support for an uninterrupted continuum of care from prenatal health, through any resultant NICU stay, and all the way to one full year of life. Our team of neonatologists, pediatricians, and NICU nurses provide continuity of care in collaboration with providers from hospital to caregivers at home and throughout the first year of life. We help overcome systemic barriers to support healthier pregnancies and healthier starts to life for all moms and babies, one family at a time.

Job Role

The Clinical RN Chart Reviewer will perform clinical reviews of medical records and other documentation to validate issues of claims coding accuracy, medical necessity, and the appropriateness of treatment settings and services delivered. The Clinical RN Chart Reviewer will report to the Payment Assurance Manager and support a culture and work environment that promotes and inspires an active, continuous improvement philosophy regarding products and services in line with our company mission.

Responsibilities will include:

1. Audits and analyzes neonatal intensive care unit (NICU) claims according to ICD-10 coding principles and clinical guidelines.
2. Analysis of claims data to optimize reimbursement by ensuring that the diagnosis codes, procedure codes, and supporting documentation accurately support the service rendered.
3. Ensures claims analysis complies with ethical coding standards, guidelines, and regulatory requirements.
4. Responsible for performing clinical reviews of medical records and other documentation to validate issues of claims coding accuracy, medical necessity, and the appropriateness of treatment settings and services delivered.
5. Research reimbursement regulations for claim payment compliance to support and validate audit findings.
6. Assist with the development of claims audit process documentation, including workflow diagrams, policies and procedures, and standard operating procedures.

Qualifications:

1. Registered Nurse required.
2. Inpatient Coding Certification required - CCS or CIC.
3. Experience in nursing, inpatient coding and reimbursement guidelines, and specifically, has a solid understanding of the MS-DRG, AP-DRG and APR-DRG payment systems.
4. 3+ 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.
5. Adherence to official coding guidelines, coding clinic determinations, and CMS and other regulatory compliance guidelines and mandates.
6. Requires expert coding knowledge - DRG, ICD-10, CPT, HCPCS codes.
7. Excellent communication skills, both oral and written.
8. Strong interpersonal skills that will support collaborative teamwork.
9. Proficient in Microsoft Office: Word and Excel; Access – highly preferred.
10. Ability to work independently and within a team.
11. Critical listening, thinking, decision making and problem solving.

Benefits:

• 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

ProgenyHealth positively recruits people from diverse backgrounds, including individuals with disabilities - if you need an accommodation to interview, please contact us by email: [e-mail]

Equal Opportunity Employer, including individuals with disabilities and veterans.