Nurse Inpatient Coding Auditor, CIC or CCS certified

🔥 6 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

🔎 Auditor

👻 Ghost score 12%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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ProgenyHealth, LLC

WebsiteLinkedInAll Job Openings

201 - 500 employees

🏥 Healthcare

⚕️ Healthcare Insurance

☁️ SaaS

Healthcare • Healthcare Insurance • SaaS

ProgenyHealth, LLC is a company focused on transforming healthcare for women, infants, and families through its integrated Maternity and NICU Care Management solutions. With over 20 years of experience, ProgenyHealth provides a comprehensive care management solution to address the maternity and NICU challenges faced by modern health plans. By identifying risks early, the company aims to prevent preterm births, NICU stays, and complications during pregnancy and after delivery. ProgenyHealth operates as a trusted partner for health plans, overseeing a full maternal and infant care continuum, creating lasting relationships, and optimizing maternal and infant healthcare economics. The company also helps solve non-clinical social drivers impacting maternal and infant health, ensuring equitable, standardized, and predictable family care.

📋 Description

• Perform clinical reviews of medical records and other documentation to validate claims coding accuracy, medical necessity, and appropriateness of treatment settings and services delivered • Report to the Payment Assurance Manager • Audit and analyze neonatal intensive care unit (NICU) claims according to ICD-10 coding principles and clinical guidelines • Analyze claims data to optimize reimbursement by ensuring diagnosis codes, procedure codes, and supporting documentation accurately support services rendered • Ensure claims analysis complies with ethical coding standards, guidelines, and regulatory requirements • Utilize Clinical Review Tools and EMR Systems • Research reimbursement regulations for claim payment compliance to support and validate audit findings • Assist with developing claims audit process documentation, workflow diagrams, policies and procedures, and standard operating procedures • Detect discrepancies in provider billing and recommend adjustments to ensure proper reimbursement • Support a culture and work environment promoting continuous improvement regarding products and services

🎯 Requirements

• Registered Nurse required • 2+ years with inpatient claims, preferably NICU and maternity required • Inpatient Coding Certification required - CCS or CIC • If not currently certified, requirement to obtain CIC or CCS within 6 months of hire • Applicant responsible for exam and associated fees • Experience in nursing, inpatient coding and reimbursement guidelines • Solid understanding of the MS-DRG, AP-DRG and APR-DRG payment systems • 2+ years of working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG • Broad knowledge of medical claims billing/payment systems, provider billing guidelines, payer reimbursement policies, medical necessity criteria and coding terminology • Adherence to official coding guidelines, coding clinic determinations, and CMS and other regulatory compliance guidelines and mandates • Expert coding knowledge - DRG, ICD-10, CPT, HCPCS codes • Experience with appeals is strongly preferred • Excellent communication skills, both oral and written • Strong interpersonal skills that will support collaborative teamwork • Proficient in Microsoft Office: Word and Excel; Access – highly preferred • Ability to work independently and within a team • Critical listening, thinking, decision making and problem solving

🏖️ Benefits

• Paid Time Off • Paid Parental Leave • Medical, dental, vision benefits • 401K with company match • Short- and Long-Term Disability • Group Life Insurance • Tuition reimbursement • Professional development opportunities • Business Casual work environment