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Nurse Coder DRG Auditor III
TREND Health Partners
Remote, USA
Full-time
Senior
Remote
USD 97000-117000 yearly / year
Discovered 1 weeks ago
Microsoft OfficeCenters for Medicare and Medicaid Services (CMS)InterQualMCGCPTICD-10
Free
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Ready to ScanKey skills for this role
Microsoft OfficeCenters for Medicare and Medicaid Services (CMS)InterQual
Key Skills for This Role
Microsoft OfficeCenters for Medicare and Medicaid Services (CMS)InterQualMCGCPTICD-10
Full Job Posting
- Utilize coding guidelines and clinical guidelines to perform DRG or APC validation
- Validate principal diagnosis, secondary diagnoses, sequencing of diagnoses, discharge statuses and procedures utilizing the medical record
- Evaluate short stay claims for medical necessity of an inpatient level of care
- Apply CPT and ICD-10 guidelines
- Apply policies, procedures, guidelines and regulations developed by Centers for Medicare and Medicaid Services (CMS), commercial payers, InterQual, MCG, and Trend Health Partners
- Provide appeal responses for claims of the above types utilizing industry standards and company/client policies
- Assist with new concept development
- Assist with claim selection criteria
- Assist with itemized bill review as needed
- Maintain licensures, certifications and continuing education requirements
- May require client communication to support findings
- Independently apply and establish guidelines for others to apply coding guidelines
- Performs quality checks for other team members
- An active RN professional license in good standing
- Clinical practice experience
- Coding certification in good standing. Examples: CCS, 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
- Appeals experience a plus
- APR-DRG experience a plus
- Client communication experience a plus
- Concept development experience a plus
- Claim selection experience a plus
- Experience with machine learning/artificial intelligence a plus
- Case Management and/or Utilization Review experience a plus
- Clinical Documentation Improvement experience a plus
- Itemized bill validation experience a plus
- Quality Assurance experience a plus
- Management experience a plus
- Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) a plus
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