Clinical DRG Auditor (Remote in US)
Any city, AR, US, 99999
It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.
Summary
We are seeking a talented individual for a full-time Clinical DRG Auditor who is responsible for performing DRG validation (clinical/coding) reviews of medical records and/or other documentation to validate the conditions that were documented in the medical record, the ICD-10-CM/PCS code assignments and determine the accuracy of DRG assignment that is clinically supported as defined by review methodologies specific to the contract for which review services are being provided. This involves accessing proprietary systems to audit medical records, accurately documenting findings and providing policy/regulatory support for determination. The candidate must have extensive clinical experience with a background in auditing medical records with a high level of understanding payment methodologies including MS-DRG, AP-DRG and APR-DRG.
What you will do
- Performs audits of medical record documentation to determine the accuracy of principal and secondary diagnosis (including MCC & CC) and procedure codes. Adheres to official coding guidelines, coding clinics and regulatory guidelines and mandates. Draws on advanced ICD-10 coding expertise and clinical knowledge to substantiate conclusions. Utilizes HMS proprietary auditing systems with a high level of proficiency to document audit determinations and rationale. Applies clinical review judgment to make coding validation determinations including sequencing ICD-10-CM, ICD-10-PCS procedural codes for inpatient claims.
- Consistently achieves productivity and quality performance standards established by management.
- Assists management with training new Coders or Clinical DRG Auditors to include daily monitoring, mentoring, feedback and education.
- Maintains current knowledge of coding guidelines and successfully completes required CEUs to maintain RN license and coding certification
- Responsible for attending training and scheduled meetings to enhance skills and working knowledge of clinical policies, procedures, rules, and regulations.
What we are looking for
- Active and unrestricted RN license required
- One of the following Coding Certifications within 1 year of …
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Orientation Video cameras must be used during all interviews
Benefits/PerksCareer development Comprehensive health benefits Continuous learning Development academies Educational Assistance Flexible hours Flexible Vacation Flexible vacation policy Generous, flexible vacation policy Health benefits Inclusive workplace Leadership and technical development academies Medical Technical development academies Vacation policy Work flexibility Work From Home Work-life balance
Tasks- Code
- Documentation
- Document findings
- Leadership
- Test
- Training
APR-DRG Audit Auditing Claims Clinical Experience Clinical Review CMS Coding Coding Guidelines Collaboration Computer Development Documentation Excel Go Healthcare ICD-10 Coding Innovation Leadership Medical Medical Record Review Microsoft Excel Microsoft Outlook Microsoft PowerPoint Microsoft Teams Microsoft Windows Microsoft Word MS-DRG Outlook PowerPoint Regulatory Guidelines Reporting Teams Training Word Zoom
Experience5 years
Education CertificationsCCDS CCS CIC CPC RHIA RHIT RN License
TimezonesAmerica/Anchorage America/Chicago America/Denver America/Los_Angeles America/New_York Pacific/Honolulu UTC-10 UTC-5 UTC-6 UTC-7 UTC-8 UTC-9