DRG Coding Auditor

Job not on LinkedIn

October 1

Apply Now

Receive Emails with Similar Jobs

Tenet Healthcare

WebsiteLinkedInAll Job Openings

Healthcare • Biotechnology • Wellness

Tenet Healthcare is a leading healthcare services company that owns and operates hospitals, outpatient centers, and other healthcare facilities. With a focus on providing high-quality and accessible medical care to communities across the United States, Tenet Healthcare is committed to improving patient outcomes and enhancing the healthcare experience. They also offer innovative treatment options and invest in health technology to support their mission of delivering exceptional care.

10,000+ employees

🧬 Biotechnology

🧘 Wellness

💰 $2G Post-IPO Debt on 2022-05

📋 Description

• Conduct coding and documentation quality reviews and generate responses for cases denied by payors. • Formulates and submits letters of appeal utilizing relevant clinical documentation from the medical record. • Performs reviews of accounts denied for DRG validation and DRG downgrades. • Documents in appropriate denial tracking tool (ACE) and maintains reports for leadership. • Identifies payment methodology of accounts, including Managed Care contract rates and Medicare rates. • Collaborates with Physician Advisors and CRC leadership for documentation-specific areas of concern. • Maintains expertise in clinical areas and current trends in healthcare, inpatient coding, and reimbursement methodologies.

🎯 Requirements

• Completion of BSN Degree Program or three years of experience and completion of BSN within five years of employment • RN License in the State of Practice • Current working knowledge of clinical documentation and inpatient coding, discharge planning, utilization management, case management, performance improvement and managed care reimbursement. • Three to Five years Clinical RN Experience • Three to Five years of Clinical Documentation Integrity experience • Must have expertise with Interqual and/or MCG Disease Management Ideologies • Strong understanding of rules and guidelines, including AHA’s Coding Clinics, American Association of Medical Audit Specialists (AAMAS), National Commission on Insurance Guidelines and Medicare Billing Guidelines (CMS), State Funded Billing Regulations (Arizona, California, Nevada) and grievance process; working knowledge of billing codes such as RBRVS, CPT, ICD-10, HCPCS.

🏖️ Benefits

• Medical, dental, vision, disability, life, and business travel insurance • Paid time off (vacation & sick leave) – min of 12 days per year, accrued at a rate of approximately 1.84 hours per 40 hours worked. • 401k with up to 6% employer match • 10 paid holidays per year • Health savings accounts, healthcare & dependent flexible spending accounts • Employee Assistance program, Employee discount program • Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance. • For Colorado employees, Conifer offers paid leave in accordance with Colorado’s Healthy Families and Workplaces Act.