Remote DRG Quality Auditor & Clinical Coding Specialist

Ultipro; Fort Worth (TX); Hybrid; USD 70,000 - 95,000; Full time

Job summary

CERIS in Fort Worth, TX is seeking a DRG Quality Control/Clinical Auditor to perform DRG validation reviews of medical records and documentation. This remote role requires ICD-10-CM/PCS expertise, strong communication, and knowledge of payer rules (Medicare/Medicaid).

Licensure as RN or LVN preferred with 2+ years DRG auditing experience. Ideal candidates have clinical knowledge of disease processes and ability to work independently in a fast-paced environment, with a focus on accurate

Qualifications

• LVN or RN license in the state of employment preferred.
• Experience in the OR, ICU, or ER as an RN highly preferred.
• Minimum 2 years DRG Quality Auditing experience in hospital or health plan; National Coding Certification required (AHIMA or AAPC).
• Extensive hands-on ICD-10-CM/PCS experience required.

Responsibilities

• Review medical records to determine accuracy of billing through verification of coding and review of supporting clinical documentation.
• Check for physician's notes supporting the DRGs assigned.
• Conduct audits to ensure accurate reimbursement and identify potential savings.
• Review previously conducted audits to ensure accurate coding and identify potential savings.
• Review all opportunities sent to customers for complete and correct information.
• Demonstrated knowledge of ICD-10-CM codes, PCS and DRG coding; payer rules incl. Medicare/Medicaid.
• Understand and comply with internal and external policies.
• HIPAA Privacy and Security Rules knowledge.
• Assist Quality Control team and medical director with appeals, rebuttals, etc.
• Notify leadership of issues or concerns in timely manner.
• Additional duties as assigned.

Skills

DRG coding

ICD-10-CM/PCS

Coding guidelines

Communication skills

HIPAA knowledge

Independent work

Attention to detail

MS Office

DRG expertise

Education

RN or LVN license

National Coding Certification (AHIMA/AAPC)

Tools

Microsoft Office

Job description

CERIS in Fort Worth, TX is seeking a DRG Quality Control/Clinical Auditor to perform DRG validation reviews of medical records and documentation. This remote role requires ICD-10-CM/PCS expertise, strong communication, and knowledge of payer rules (Medicare/Medicaid).

Licensure as RN or LVN preferred with 2+ years DRG auditing experience. Ideal candidates have clinical knowledge of disease processes and ability to work independently in a fast-paced environment, with a focus on accurate