Remote DRG Coding & Clinical Validation Analyst

Excellus BCBS; United States; Hybrid; USD 65,000 - 142,000; Full time

Job summary

Excellus BCBS is seeking a Payment Integrity DRG Coding & Clinical Validation Analyst with extensive experience in acute facility-based documentation and inpatient coding to validate DRG assignments.

You will review medical records for principal diagnosis, co-morbidities and POA indicators to ensure documentation supports coded data, while complying with CMS guidelines and audits. Some remote work may be available.

Qualifications

• Associate or bachelor’s degree in health information management (RHIA or RHIT) or a Nursing Degree.
• Three (3) years’ experience in claims auditing, quality assurance, or recovery auditing for DRG coding.
• Three (3) years with ICD-10-CM, MS-DRG, and APR-DRG coding knowledge.

Responsibilities

• Analyzes and audits acute inpatient claims and ensures accurate DRG coding.
• Adheres to official coding guidelines and CMS regulations and audits.
• Mentors new hires and leads complex audits as needed.

Skills

ICD-10 coding

DRG & APR-DRG

Auditing

Healthcare claims knowledge

Analytical skills

Education

RHIA or RHIT or Nursing Degree

Coding Certification CCS or CIC

Tools

Auditing tools

Claims processing systems

PC software

Job description

Excellus BCBS is seeking a Payment Integrity DRG Coding & Clinical Validation Analyst with extensive experience in acute facility-based documentation and inpatient coding to validate DRG assignments.

You will review medical records for principal diagnosis, co-morbidities and POA indicators to ensure documentation supports coded data, while complying with CMS guidelines and audits. Some remote work may be available.