Senior IRF Audit & Coding SME

Optum; Plymouth (MN); A distancia; USD 113.000 - 193.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Comprehensive benefits package

Equity stock purchase program

401k contribution

Descripción de la vacante

Optum is seeking a knowledgeable IRF coding and auditing professional to validate CMG assignments and functional scores, ensuring accuracy and identifying revenue-impacting misclassifications. You will apply CMS Grouper logic and collaborate with analytics to refine audit strategies.

Required are clinical or coding licensures with 5+ years in IRF related work. This remote role offers comprehensive benefits and the chance to influence payer-verification processes.

Formación

• Clinical licensure in nursing or therapy.
• Coding licensure with IRF experience.
• 5+ years in IRF coding/auditing or related fields.

Responsabilidades

• Validate CMG assignment accuracy and functional scoring (IRF PAI GG).
• Identify overpayments/underpayments tied to CMG tiering misclassification.
• Apply CMS Grouper logic to validate CMG outcomes.
• Evaluate alignment between medical records, IRF PAI scores, and ICD-10 coding.

Conocimientos

IRF coding/auditing

Regulatory guidance application

Data analysis

Communication with clients

Audit & investigation mindset

Educación

Clinical licensure (RN/PT/OT/SLP)

Coding licensure (RHIA/RHIT/CCS/CPC)

Herramientas

IRF Grouper tools

CMS Web Pricer

CMG logic

Data analytics platforms

Descripción del empleo

Optum is seeking a knowledgeable IRF coding and auditing professional to validate CMG assignments and functional scores, ensuring accuracy and identifying revenue-impacting misclassifications. You will apply CMS Grouper logic and collaborate with analytics to refine audit strategies.

Required are clinical or coding licensures with 5+ years in IRF related work. This remote role offers comprehensive benefits and the chance to influence payer-verification processes.