DRG Clinical Validation Nurse

🔥 12 minutes ago

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MedReview Inc.

WebsiteLinkedInAll Job Openings

201 - 500 employees

🏥 Healthcare

⚕️ Healthcare Insurance

💸 Finance

Healthcare • Healthcare Insurance • Finance

MedReview Inc. is a leading provider of advanced payment integrity solutions, specializing in healthcare claims. They work with a wide range of clients, including health plans, government agencies, and payors, to reduce unnecessary waste and save billions of dollars. Their team of highly trained physicians, registered nurses, and certified coders conduct thorough clinical and coding reviews to identify inaccuracies in healthcare claims. MedReview employs proprietary algorithms to analyze complex data and detect suspicious payment trends, offering a unique blend of clinical expertise and advanced technology to maximize efficiencies and improve healthcare cost management.

📋 Description

• Perform clinical validation by ensuring diagnosis codes billed by the provider are supported within the medical record • Must be able to interpret clinical guidelines/criteria and apply to clinical review • Solid understanding of anatomy and physiology, diagnostic and surgical procedures developed from specialized training and extensive experience with ICD-10-PCS code assignments • Demonstrates the ability to accurately interpret the medical record • Writes clear, accurate and concise rationales in support of findings • Maintains and manages case reviews with a high emphasis on quality • Demonstrates the ability to work in a high – volume production environment • Knowledge of health insurance business, industry terminology, and regulatory guidelines

🎯 Requirements

• Minimum of two years’ experience in clinical validation in a payment integrity setting required • May consider nurses with inpatient claims auditing experience or case management experience. • Unrestricted Registered Nurse with active RN licensure required • CCS (Certified Coding Specialist) or CIC (Certified Inpatient Coder) certification preferred • CCDS or CDIP Certification preferred • Knowledge of ICD-10 coding • Basic Knowledge of DRG validation and coding • Ability to use Windows PC with the ability to utilize multiple applications at the same time.

🏖️ Benefits

• Healthcare that fits your needs - We offer excellent medical, dental, and vision plan options that provide coverage to employees and dependents. • 401(k) with Employer Match - Join the team and we will invest in your future • Generous Paid Time Off - Accrued PTO starting day one, plus additional days off when you’re not feeling well, to observe holidays. • Wellness - We care about your well-being. From Commuter Benefits to FSAs, we’ve got you covered. • Learning & Development - Through continued education/mentorship on the job and our investment in LinkedIn Learning, we’re focused on your growth as a working professional.