Remote DRG Validation RN Auditor

CSI Companies; United States; Remote; USD 80,000 - 100,000; Full time

Job summary

Join a forward-thinking company as a Remote DRG Validation RN Auditor, where you'll leverage your expertise in MS-DRG and APR-DRG coding to ensure accuracy in inpatient claims. This role provides an exciting opportunity to work with a top-ranked healthcare client, recognized for its commitment to quality and social responsibility. You'll utilize your analytical skills and coding knowledge to identify overpayments and provide crucial insights that impact healthcare delivery. Enjoy the flexibility of remote work while contributing to a team dedicated to improving healthcare systems for future generations.

Benefits

Weekly pay

Medical coverage

Dental coverage

Vision coverage

Paid Training

Opportunity for advancement

Qualifications

• 3+ years of MS DRG and APR DRG coding experience in a hospital environment.
• Expert knowledge of ICD-10 Official Coding Guidelines and DRG reimbursement methodologies.

Responsibilities

• Conduct MS-DRG and APR-DRG coding reviews to verify DRG assignment accuracy.
• Write clear rationales supporting audit findings using coding guidelines.

Skills

ICD-10 Coding

DRG Methodologies

Clinical Coding Review

Communication Skills

Analytical Skills

Attention to Detail

Time Management

Education

Associate Degree

Bachelor of Arts

Tools

DRG Encoder Tools

Microsoft Excel

Proprietary Workflow Systems

Job description

This range is provided by CSI Companies. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$38.00/hr - $43.00/hr

Direct message the job poster from CSI Companies

Recruiter @ CSI Companies | Bachelor of Arts University of Tennessee Knoxville

Do you want to work for a company that Forbes named one of the Top 50 Most Innovative Companies? Are you looking to fast-track your career with one of LinkedIn's top companies in the U.S.? If so, keep reading!

CSI Companies is hiring a Remote DRG Validation RN Auditor for our Fortune 100 healthcare

Location: Remote (United States)

Pay: $38-43/hour based on experience, certifications, and education (overtime will be paid at 1.5 times the normal hourly pay rate).

Hours: Full-time hours; Monday to Friday; standard business hours

Status: Contract to Hire

Effective Date / Tentative Start Date: Interviewing Immediately

Job Summary

We are seeking a Remote DRG Validation RN Auditor to apply your expert knowledge of the MS-DRG and APR-DRG coding/reimbursement methodology systems, ICD-10 Official Coding Guidelines, and AHA Coding Clinic Guidelines in the auditing of inpatient claims. Employing both industry and Company proprietary tools, you will validate ICD-10 diagnosis and procedure codes, DRG assignments, and discharge statuses billed by hospitals to identify overpayments. Utilizing excellent communications skills, you will compose rationales supporting your audit findings.

Why this Opportunity?

• Top ranked company in Fortune’s 2024 “World’s Most Admired Companies” for over a decade consecutively.
• This healthcare client is ranked number one in key attributes of reputation:
• Social responsibility
• Quality of Management
• Financial soundness
• Quality of products
• Services and global competitiveness.

Job Duties:

• Conduct MS-DRG and APR-DRG coding reviews to verify the accuracy of DRG assignment and reimbursement with a focus on overpayment identification
• Expert knowledge of and the ability to: identify the ICD-10-CM/PCS code assignment, appropriate code sequencing, present on admission (POA) assignment, and discharge disposition, in accordance with CMS requirements, ICD-10 Official Guidelines for Coding and Reporting, and AHA Coding Clinic guidance
• Must be fluent in the application of current ICD-10 Official Coding Guidelines and AHA Coding Clinic citations, in addition to demonstrating working knowledge of clinical criteria documentation requirements used to successfully substantiate code assignments
• Perform clinical coding review to ensure accuracy of medical coding and utilizes clinical expertise and judgment to determine correct coding and billing
• Solid command of anatomy and physiology, diagnostic procedures, and surgical operations developed from specialized training and extensive experience with ICD-10-PCS code assignment
• Writes clear, accurate and concise rationales in support of findings using ICD-10 CM/PCS Official Coding Guidelines, and AHA Coding Clinics
• Utilize proprietary workflow systems and encoder tool efficiently and accurately to make audit determinations, generate audit rationales and move claims through workflow process correctly
• Demonstrate knowledge of and compliance with changes and updates to coding guidelines, reimbursement trends, and client processes and requirements
• Maintain and manages daily case review assignments, with a high emphasis on quality
• Provide clinical support and expertise to the other investigative and analytical areas
• Will be working in a high-volume production environment that is matrix driven
• CCS/CIC or will obtain within 6 months of hire
• 3+ years of MS DRG and APR DRG coding experience in a hospital environment with expert knowledge of ICD-10 Official Coding Guidelines and DRG reimbursement methodologies
• Expert knowledge of ICD-10-CM coding including but not limited to: expert knowledge of principal diagnosis selection, complications/comorbidities (CCs) and major complications/comorbidities (MCCs), and conditions that impact severity of illness (SOI) and risk of mortality (ROM)
• Expert knowledge of ICD-10-PCS coding including but not limited to: expert knowledge of the structural components of PCS including but not limited to: selection of appropriate body systems, root operations, body parts, approaches, devices, and qualifiers
• Ability to use a Windows PC with the ability to utilize multiple applications at the same time
• Demonstrate excellent written and verbal communication skills, strong analytical skills, and attention to detail
• Ability to work independently in a remote environment and deliver exceptional results
• Excellent time management and work prioritization skills
• Verifiable Associate Degree or higher
• High-speed internet on your own private home network

Highly Preferred

• Previous experience in managed care environments is highly desirable.
• Large corporation experience and Health plan / managed care / healthcare industry experience.
• Experience with prior DRG concurrent and/or retrospective overpayment identification audits
• Experience with readmission reviews of claims
• Experience with DRG encoder tools (ex. 3M)
• Experience using Microsoft Excel with the ability to create / edit spreadsheets, use sort / filter function, and perform data entry
• Healthcare claims experience

WHO SHOULD APPLY?

If you're a RN with experience with MR DRG and Apr DRG coding in a hospital environment, we’d love for you to apply!

Apply to become part of the team that is not only changing people’s lives for the better but changing the health care system for the next generations to come.

About Us

CSI Companies is a recruiting firm established in 1994 that has been awarded “Best of Staffing” for over a decade. We provide outstanding services to the world’s leaders in the healthcare field as well as other organizations. For consideration, please submit your resume with all of your relevant experience included on it for immediate consideration. Only those candidates identified for an interview will be contacted.

Benefits Offered:

• Weekly pay
• Medical, dental, and vision coverage
• Voluntary Life and AD&D coverage
• Paid Training
• Opportunity for advancement upon performance and availability

Seniority level

• Seniority level

  Associate

Employment type

• Employment type

  Full-time

Job function

• Job function

  Accounting/Auditing and Health Care Provider

• Industries

  Hospitals and Health Care

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