Nurse Coder, DRG Auditor I

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Trend Health Partners

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Healthcare Insurance • Fintech • Artificial Intelligence

Trend Health Partners is a healthcare technology company focused on enhancing payer-provider collaboration to improve financial management in healthcare. By leveraging AI-enabled technology, Trend Health Partners offers solutions to reduce credit balances, minimize payment denials, and ensure payment accuracy, ultimately fostering better relationships among stakeholders in the healthcare ecosystem. With a commitment to neutrality and efficiency, they aim to reshape the healthcare financial landscape for the benefit of providers, payers, and patients alike.

201 - 500 employees

Founded 2018

⚕️ Healthcare Insurance

💳 Fintech

🤖 Artificial Intelligence

💰 Private Equity Round on 2023-01

📋 Description

• review medical records and associated claim information to validate accuracy of DRG assignments and/or medical necessity for inpatient level of care • Utilize coding guidelines and clinical guidelines to perform DRG validation • Validate principal diagnosis, secondary diagnoses, sequencing of diagnoses, discharge statuses and procedures utilizing the medical record • Evaluate short stay claims for medical necessity of an inpatient level of care • Apply CPT and ICD-10 guidelines • Apply policies, procedures, guidelines and regulations developed by Centers for Medicare and Medicaid Services (CMS), commercial payers, InterQual, MCG, and Trend Health Partners • Provide appeal responses for claims of the above types utilizing industry standards and company/client policies • Assist with new concept development • Assist with claim selection criteria • Assist with itemized bill review as needed • Maintain licensures, certifications and continuing education requirements • May require client communication to support findings

🎯 Requirements

• An active RN professional license in good standing • 5 years of clinical practice • Coding certification in good standing. Examples: CCS, CPC, CIC • 2-5 years coding validation/auditing experience • Well-developed verbal and written communication skills coupled with recognizable organization • Ability to effectively prioritize tasks • Microsoft Office experience, specifically Excel

🏖️ Benefits

• competitive salaries • highly valued health insurance • 401(k) plan with employer match • paid parental leave