Remote DRG Auditor RN – Clinical Validation & Coding

Stryker Corporation; Plymouth (MN); Hybrid; Confidential; Full time

Benefits offered by this job

Sign-on bonus

Job summary

UnitedHealth Group is seeking a Clinical DRG RN auditor to apply expert MS-DRG/APR-DRG coding knowledge and ICD-10 guidelines in inpatient claims audits. This remote role allows telecommuting from anywhere in the U.S. with a sign-on bonus for external applicants.

Responsibilities include conducting coding reviews, verifying DRG assignments, and drafting rationales using CMS requirements and AHA guidance. A RN license and CCS/CIC certification (or willingness) are required.

Qualifications

• Associate's degree and unrestricted RN license.
• CCS/CIC certification or willingness to obtain within 6 months of hire.
• 2+ years MS-DRG/APR-DRG coding experience in hospital settings.

Responsibilities

• Conduct MS-DRG and APR-DRG coding reviews to verify DRG assignments and reimbursement.
• Identify ICD-10-CM/PCS code assignment and sequencing per CMS guidelines and AHA Coding Clinic guidance.
• Substantiate code assignments with supporting documentation using ICD-10 Official Guidelines.
• Perform clinical coding review to ensure accuracy of medical coding and billing.
• Use encoder tools to move claims through workflow and generate audit rationales.

Skills

MS-DRG auditing

ICD-10 coding

RN license

Education

Associate's degree

Tools

DRG encoder tools

Job description

UnitedHealth Group is seeking a Clinical DRG RN auditor to apply expert MS-DRG/APR-DRG coding knowledge and ICD-10 guidelines in inpatient claims audits. This remote role allows telecommuting from anywhere in the U.S. with a sign-on bonus for external applicants.

Responsibilities include conducting coding reviews, verifying DRG assignments, and drafting rationales using CMS requirements and AHA guidance. A RN license and CCS/CIC certification (or willingness) are required.