DRG Quality Advisor Nurse

🕒 5 days ago

🏰 Missouri – Remote

🏰 Missouri – Remote

💵 $90k - $110k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Gainwell Technologies

WebsiteLinkedInAll Job Openings

10,000+ employees

💼 Consulting

📦 Logistics

⚕️ Healthcare Insurance

💰 Grant on 2023-06

Consulting • Logistics • Healthcare Insurance

Gainwell Technologies is the nation’s leading provider of digital and cloud-enabled solutions across the human services and public health ecosystem. With a mission-driven approach, Gainwell serves clients in all 50 U. S. states, focusing on improving health outcomes and delivering intuitive, human-centered experiences. Their comprehensive suite of solutions includes Medicaid Enterprise modernization, data analytics, provider services, and pharmacy solutions, all designed to advance the future of healthcare and enhance community well-being.

📋 Description

• Perform quality assurance checks on final review work for complex clinical claims • Conduct DRG validation reviews of medical record documentation • Review and analyze claim data and medical record documentation • Apply clinical review judgment and coding expertise to clinical determinations • Document audit findings and review determinations clearly

🎯 Requirements

• Associates degree required; Bachelor's degree preferred • Active, unrestricted RN licensure in the United States required • One of the following Coding Certifications required: RHIA, RHIT, CCS, CIC, CCDS, or CPC • 5+ years clinical experience in an inpatient hospital setting required • 3+ years of MS-DRG/APR-DRG coding or auditing experience • Expert knowledge of ICD-10-CM coding • Expert knowledge of ICD-10-PCS coding methodologies • Proficiency in Microsoft Windows, Outlook, Excel, Word, PowerPoint, and virtual meeting tools

🏖️ Benefits

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