Remote Clinical Validation Nurse - DRG & Coding Expert

MedReview Inc.; United States; On-site; USD 80,000 - 110,000; Full time

Benefits offered by this job

Healthcare plan

401(k) with employer match

Generous paid time off

Wellness programs

Learning & development

Job summary

MedReview is seeking a registered nurse with clinical validation experience to join the coding department. The role focuses on ensuring physician diagnoses billed are supported by the medical record, interpreting guidelines, and applying ICD-10-PCS knowledge in a fast-paced setting.

This full-time, remote position allows telecommuting anywhere in the United States with virtual training from home. Strong communication and analytical skills are essential for high-quality case reviews and DRG

Qualifications

• Minimum of two years’ experience in clinical validation in a payment integrity setting required.
• Unrestricted Registered Nurse with active RN licensure required.
• CCS (Certified Coding Specialist) or CIC (Certified Inpatient Coder) certification preferred.
• CCDS or CDIP Certification preferred.
• Knowledge of ICD-10 coding.
• Basic Knowledge of DRG validation and coding.
• Ability to use Windows PC with the ability to utilize multiple applications at the same time.

Responsibilities

• Perform clinical validation by ensuring diagnosis codes billed by the provider are supported within the medical record.
• Interpret clinical guidelines/criteria and apply to clinical review.
• Demonstrate understanding of anatomy and physiology, diagnostic and surgical procedures related to ICD-10-PCS coding.
• Accurately interpret the medical record and write clear, concise rationales in support of findings.
• Maintain and manage case reviews with high quality.
• Work effectively in a high-volume production environment.
• Demonstrate knowledge of health insurance business, industry terminology, and regulatory guidelines.

Skills

Clinical validation

Communication

Analytical thinking

Education

Registered Nurse licensure (RN)

CCS certification (preferred)

CIC certification (preferred)

CCD S / CDIP certification (preferred)

Tools

ICD-10 coding

Job description

MedReview is seeking a registered nurse with clinical validation experience to join the coding department. The role focuses on ensuring physician diagnoses billed are supported by the medical record, interpreting guidelines, and applying ICD-10-PCS knowledge in a fast-paced setting.

This full-time, remote position allows telecommuting anywhere in the United States with virtual training from home. Strong communication and analytical skills are essential for high-quality case reviews and DRG