DRG Coding Auditor

AuditorAuditorFull TimeRemoteTeam 10,001+H1B No SponsorCompany Site LinkedIn

Location

United States

Posted

164 days ago

Salary

$56.8K - $85.2K / year

Bachelor Degree5 yrs expEnglish

Job Description

• Conduct coding and documentation quality reviews and generate responses for cases denied by payors. • Formulates and submits letters of appeal utilizing relevant clinical documentation from the medical record. • Performs reviews of accounts denied for DRG validation and DRG downgrades. • Documents in appropriate denial tracking tool (ACE) and maintains reports for leadership. • Identifies payment methodology of accounts, including Managed Care contract rates and Medicare rates. • Collaborates with Physician Advisors and CRC leadership for documentation-specific areas of concern. • Maintains expertise in clinical areas and current trends in healthcare, inpatient coding, and reimbursement methodologies.

Job Requirements

Completion of BSN Degree Program or three years of experience and completion of BSN within five years of employment
RN License in the State of Practice
Current working knowledge of clinical documentation and inpatient coding, discharge planning, utilization management, case management, performance improvement and managed care reimbursement.
Three to Five years Clinical RN Experience
Three to Five years of Clinical Documentation Integrity experience
Must have expertise with Interqual and/or MCG Disease Management Ideologies
Strong understanding of rules and guidelines, including AHA’s Coding Clinics, American Association of Medical Audit Specialists (AAMAS), National Commission on Insurance Guidelines and Medicare Billing Guidelines (CMS), State Funded Billing Regulations (Arizona, California, Nevada) and grievance process; working knowledge of billing codes such as RBRVS, CPT, ICD-10, HCPCS.

Benefits

Medical, dental, vision, disability, life, and business travel insurance
Paid time off (vacation & sick leave) – min of 12 days per year, accrued at a rate of approximately 1.84 hours per 40 hours worked.
401k with up to 6% employer match
10 paid holidays per year
Health savings accounts, healthcare & dependent flexible spending accounts
Employee Assistance program, Employee discount program
Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.
For Colorado employees, Conifer offers paid leave in accordance with Colorado’s Healthy Families and Workplaces Act.