Clinical DRG Auditor

🕒 vor 1 Monat

🤠 Texas – Remote

🤠 Texas – Remote

💵 $85.000 - $95.000 / Jahr

⏰ Vollzeit

🟡 Mittelstufe

🟠 Senior

🔎 Auditor

🦅 H1B-Visum-Sponsor

Dieses Unternehmen hat in der Vergangenheit H1B-Visa gesponsert.

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Gainwell Technologies

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10.000+ Mitarbeiter

⚕️ Krankenversicherung

💰 Grant im 2023-06

Healthcare Insurance • Human Services • Healthcare

Gainwell Technologies ist der führende Anbieter von digitalen und cloud-fähigen Lösungen im Bereich der Human Services und der öffentlichen Gesundheit in den USA. Mit einem zielorientierten Ansatz bedient Gainwell Kunden in allen 50 US-Bundesstaaten und konzentriert sich darauf, Gesundheitsergebnisse zu verbessern und intuitive, menschzentrierte Erfahrungen zu bieten. Ihr umfassendes Lösungsspektrum umfasst die Modernisierung von Medicaid Enterprise, Datenanalysen, Anbieter-Dienstleistungen und Apothekenlösungen, die alle darauf ausgelegt sind, die Zukunft des Gesundheitswesens voranzutreiben und das Wohl der Gemeinschaft zu verbessern.

Beschreibung

• Performs audits of medical record documentation to determine the accuracy of principal and secondary diagnosis (including MCC & CC) and procedure codes. • Adheres to official coding guidelines, coding clinics and regulatory guidelines and mandates. • Draws on advanced ICD-10 coding expertise and clinical knowledge to substantiate conclusions. • Utilizes HMS proprietary auditing systems with a high level of proficiency to document audit determinations and rationale. • Applies clinical review judgment to make coding validation determinations including sequencing ICD-10-CM, ICD-10-PCS procedural codes for inpatient claims. • Consistently achieves productivity and quality performance standards established by management. • Assists management with training new Coders or Clinical DRG Auditors to include daily monitoring, mentoring, feedback and education. • Maintains current knowledge of coding guidelines and successfully completes required CEUs to maintain RN license and coding certification. • Responsible for attending training and scheduled meetings to enhance skills and working knowledge of clinical policies, procedures, rules, and regulations.

🎯 Anforderungen

• Active, unrestricted RN licensure from the United States and in the state of primary home residency • At least one of the following Coding Certifications is required and to be maintained as condition of employment: RHIA, RHIT, CCS, CIC, CCDS or CPC • 3+ years clinical experience in an inpatient hospital setting required • 2+ years of MS DRG/APR DRG coding or auditing experience 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 methodologies, code sequencing, and discharge disposition in accordance with CMS requirements, Official Guidelines for Coding and Reporting, and Coding Clinic guidance. • Demonstrated ability to apply clinical review judgment to make clinical determinations • Demonstrated proficiency in computer skills and typing, i.e., Microsoft Windows, Outlook, Excel, Word, PowerPoint, Internet browsers and in virtual meeting tools i.e., Microsoft Teams, Zoom, etc.

🏖️ Vorteile

• generous, flexible vacation policy • 401(k) employer match • comprehensive health benefits • educational assistance • leadership and technical development academies