Remote DRG Coding RN Auditor – Audit & Reimbursement Expert

UnitedHealth Group; Plymouth (MN); Remote; USD 48,000 - 87,000; Full time

Benefits offered by this job

PTO

Medical plan

Dental & Vision

401(k)

Education reimbursement

Employee discounts

EAP

Referral bonus

Voluntary benefits

Job summary

UnitedHealth Group's Optum unit is hiring a Clinical DRG RN auditor. You will apply MS-DRG/APR-DRG knowledge, ICD-10 guidelines, and AHA guidelines to audit inpatient claims and identify overpayments. This remote role allows telecommuting from anywhere in the U.S.

with a focus on accuracy and clear audit rationales. You will work in a high-volume, matrixed environment, using encoder tools and Excel, with opportunities for professional certification and career growth within a leading health care

Qualifications

• Associate's degree required.
• Unrestricted RN license required.
• CCS/CIC certification or plan to obtain within 6 months.
• 2+ years MS DRG/APR DRG coding in hospital setting.
• 2+ years ICD-10-CM coding experience including diagnoses, CCs/MCCs, SOI/ROM.

Responsibilities

• Conduct MS-DRG and APR-DRG coding reviews to verify DRG assignment and reimbursement.
• Identify ICD-10-CM/PCS code assignments, sequencing, POA, and discharge disposition per CMS and coding guidelines.
• Apply ICD-10 guidelines and Coding Clinic citations to substantiate codes.
• Perform clinical coding reviews ensuring accuracy and proper billing.
• Use anatomy/physiology and procedural knowledge for PCS coding.
• Write clear rationales for audit findings using coding guidelines.
• Utilize encoder tools to move claims through workflow correctly.
• Maintain daily case reviews with emphasis on quality.
• Provide clinical support to investigative and analytical teams.

Skills

MS DRG/APR DRG coding

ICD-10-CM/PCS coding

CMS guidelines knowledge

AHA Coding Clinic guidance

Clinical auditing

Medical terminology

Education

Associate's degree

RN license

Tools

3M DRG encoder

Microsoft Excel

Job description

UnitedHealth Group's Optum unit is hiring a Clinical DRG RN auditor. You will apply MS-DRG/APR-DRG knowledge, ICD-10 guidelines, and AHA guidelines to audit inpatient claims and identify overpayments. This remote role allows telecommuting from anywhere in the U.S.

with a focus on accuracy and clear audit rationales. You will work in a high-volume, matrixed environment, using encoder tools and Excel, with opportunities for professional certification and career growth within a leading health care