Nurse Inpatient Coding Auditor, (Remote) CIC or CCS certified

ProgenyHealth LLC; United States; Remote; USD 85,000 - 125,000; Full time

Benefits offered by this job

Paid Time Off

401K with company match

Short- and Long-Term Disability

Group Life Insurance

Business Casual work environment

Paid Parental Leave

Medical, dental, vision benefits

Tuition reimbursement

Professional development opportunities

Job summary

ProgenyHealth LLC is hiring a Nurse Inpatient Coding Auditor for a fully remote role in the United States. The Clinical RN Chart Reviewer will evaluate NICU claims for coding accuracy, medical necessity, and appropriate settings, reporting to the Payment Assurance Manager.

Required are RN licensure, 2+ years inpatient claims experience, and CCS or CIC certification (or plan to obtain within 6 months). ProgenyHealth offers comprehensive benefits and salary commensurate with experience.

Qualifications

• RN required and licensed to practice.
• 2+ years inpatient claims experience, NICU/maternity preferred.
• Inpatient coding certification required (CCS or CIC) or plan to obtain within 6 months.

Responsibilities

• Audit NICU claims per ICD-10 coding principles and clinical guidelines.
• Analyze claims data to ensure codes justify services.
• Ensure compliance with coding standards, guidelines, 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 and SOPs.
• Identify discrepancies in provider billing and recommend adjustments.

Skills

Registered Nurse

Inpatient coding

NICU experience

Excellent communication

Interpersonal skills

Education

RN license

Tools

MS-DRG knowledge

ICD-9/10CM expertise

EMR systems

Job description

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

Nurse Inpatient Coding Auditor, (Remote) CIC or CCS certified
Fully Remote Remote

Full-time

Description

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

Requirements

Responsibilities will include:

• Audits and analyzes neonatal intensive care unit (NICU) claims according to ICD-10 coding principles and clinical guidelines.
• Analysis of claims data to optimize reimbursement by ensuring that the diagnosis codes, procedure codes, and supporting documentation accurately support the service rendered.
• Ensures claims analysis complies with ethical coding standards, guidelines, and regulatory requirements.
• 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.
• Utilize Clinical Review Tools and EMR Systems.
• Research reimbursement regulations for claim payment compliance to support and validate audit findings.
• Assist with the development of claims audit process documentation, including workflow diagrams, policies and procedures, and standard operating procedures.
• Detect discrepancies in provider billing and recommend adjustments to ensure proper reimbursement.

Qualifications:

• Registered Nurse required.
• 2+ years with inpatient claims, preferably NICU and maternity required.
• Inpatient Coding Certification required - CCS or CIC If not currently certified, requirement to obtain CIC or CCS within 6 months of hire. Applicant responsible for exam and associated fees.****
• 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.
• 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.
• Adherence to official coding guidelines, coding clinic determinations, and CMS and other regulatory compliance guidelines and mandates.
• Requires expert coding knowledge - DRG, ICD-10, CPT, HCPCS codes.
• Experience with appeals is strongly preferred.
• Excellent communication skills, both oral and written.
• Strong interpersonal skills that will support collaborative teamwork.
• Proficient in Microsoft Office: Word and Excel; Access – highly preferred.
• Ability to work independently and within a team.
• Critical listening, thinking, decision making and problem solving.

Some of the benefits we offer our team are:

• Paid Time Off
• 401K with company match
• Short- and Long-Term Disability
• Group Life Insurance
• Business Casual work environment

Responsibilities will include:

• Audits and analyzes neonatal intensive care unit (NICU) claims according to ICD-10 coding principles and clinical guidelines.
• Analysis of claims data to optimize reimbursement by ensuring that the diagnosis codes, procedure codes, and supporting documentation accurately support the service rendered.
• Ensures claims analysis complies with ethical coding standards, guidelines, and regulatory requirements.
• 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.
• Utilize Clinical Review Tools and EMR Systems.
• Research reimbursement regulations for claim payment compliance to support and validate audit findings.
• Assist with the development of claims audit process documentation, including workflow diagrams, policies and procedures, and standard operating procedures.
• Detect discrepancies in provider billing and recommend adjustments to ensure proper reimbursement.

Qualifications:

• Registered Nurse required.
• 2+ years with inpatient claims, preferably NICU and maternity required.
• Inpatient Coding Certification required - CCS or CIC If not currently certified, requirement to obtain CIC or CCS within 6 months of hire. Applicant responsible for exam and associated fees.****
• 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.
• 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.
• Adherence to official coding guidelines, coding clinic determinations, and CMS and other regulatory compliance guidelines and mandates.
• Requires expert coding knowledge - DRG, ICD-10, CPT, HCPCS codes.
• Experience with appeals is strongly preferred.
• Excellent communication skills, both oral and written.
• Strong interpersonal skills that will support collaborative teamwork.
• Proficient in Microsoft Office: Word and Excel; Access – highly preferred.
• Ability to work independently and within a team.
• Critical listening, thinking, decision making and problem solving.

Benefits

Some of the benefits we offer our team are:

• 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.