Nurse Coder, DRG Auditor III

🔥 12 hours ago

🇺🇸 United States – Remote

💵 $97k - $117k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

👻 Ghost score 1%

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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Trend Health Partners

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2018

🏥 Healthcare

⚕️ Healthcare Insurance

💳 Fintech

💰 Private Equity Round on 2023-01

Healthcare • Healthcare Insurance • Fintech

Trend Health Partners is a healthcare technology company focused on enhancing payer-provider collaboration to improve financial management in healthcare. By leveraging AI-enabled technology, Trend Health Partners offers solutions to reduce credit balances, minimize payment denials, and ensure payment accuracy, ultimately fostering better relationships among stakeholders in the healthcare ecosystem. With a commitment to neutrality and efficiency, they aim to reshape the healthcare financial landscape for the benefit of providers, payers, and patients alike.

📋 Description

• Operate as a Subject Matter Expert • Independently audit outpatient and inpatient claims using coding guidelines and supporting medical documentation • Complete appeal responses and communicate findings • Independently validate and perform quality checks for other team members • Exercise strategic decision-making authority • Support management with enterprise-level recommendations • Utilize coding and clinical guidelines to perform DRG or APC validation • Validate principal diagnosis, secondary diagnoses, sequencing of diagnoses, discharge statuses, and procedures using medical records • Evaluate short-stay claims for medical necessity of inpatient-level care • Apply CPT and ICD-10 guidelines • Apply policies, procedures, guidelines, and regulations from CMS, commercial payers, InterQual, MCG, and TREND Health Partners • Assist with new concept development and claim selection criteria • Assist with itemized bill review as needed • Maintain licensures, certifications, and continuing education requirements • Communicate with clients as needed to support findings • Independently apply and establish coding guidelines for others • Perform quality checks for other team members • Perform other duties as assigned

🎯 Requirements

• An active RN professional license in good standing • Clinical practice experience • Coding certification in good standing, such as CCS or CIC • Coding validation/auditing experience • Well-developed verbal and written communication skills coupled with recognizable organization • Ability to effectively prioritize tasks • Microsoft Office experience, specifically Excel • Employees may be required to complete background and drug screenings and disclose personal health information or personally identifiable information for Business Partners • Reasonable accommodations may be made for individuals with disabilities

🏖️ Benefits

• Competitive salaries • Health insurance • 401(k) plan with employer match • Paid parental leave • Collaborative and innovative work environment