Are you an ICD-10-CM/PCS coding guru? Would you prefer to read a medical record over the latest James Patterson book at the cabin this fall? Do you like to enjoy your work, have FUN, AND get paid? Read on…
ClaimLogiq is looking to add two skilled DRG Auditors to our growing team. You will utilize data analytics and proprietary algorithms to perform prebill or post bill DRG and clinical validation reviews to identify revenue integrity issues.
Essential Duties and Responsibilities:
- Responsible for auditing documentation to support coding and billing regulations to ensure reimbursement accuracy
- Perform comprehensive analytical review of clinical guidelines in observance of organizational quality standards to determine if an appeal is warranted/if savings are possible
- Provide detailed and easily understandable rationale and supporting evidence for recommendation and findings
- Review patient medical records and utilize clinical and regulatory knowledge and skills along with payer requirements
- Prepare convincing arguments to provider or payer reconsiderations using pre-existing criteria and/or clinical evidence
Skills, Knowledge, Education, and Experience
- Background of 3 to 5 years of DRG Chart Auditing, preferred
- Coding Certification (at least one of the following are required and are to be maintained as a condition of employment)
- Nursing-RN - Registered Nurse (preferred) with (current licensure) + CCS or CIC/CPC-H, or
- RHIA - Registered Health Information Administrator + CCS or CIC/CPC-H, or
- RHIT- Registered Health Information Technician + CCS or CIC/CPC-H, or
- CCS - Certified Coding Specialist, or
- CPC-H, Certified Professional Coder-H (Hospital Based), or
- CIC, Certified Inpatient Coder
- Experience independently structuring and executing complex analyses
- High standards of quality and attention to detail, deep patterns of curiosity, and mastery to understand the root cause of events and behaviors
- Demonstrated ability to apply critical review judgment to make clinical and/or coding determinations.
- Demonstrated understanding of the APR-DRG, MS-DRG, ICD-10, clinical criteria, and clinical review judgement.
- Be a critical thinker. Actively and skillfully conceptualize, apply, analyze, and evaluate information gathered from, or generated by observation, experience, reflection, reasoning, or communication as a guide to validate audit results and correct as necessary.
- Highly adaptable. As a small organization, our teams are nimble and expected to step from one working task to another.
- Proactive and self-directed.
- Communicates clearly, proactively, and concisely with all key stakeholders.
- Excellent written and verbal communication skills.
- Will actively seek out new ideas, possibilities, and answers to tough questions.
Computer Equipment and Software
- Proficient in MS Office and teams, Skype, WebEx, VPN access, navigation of various EHRs and MR formats, and the ability to problem solve internet connectivity and minor computer issues in a work-from-home environment.
- Requires the ability to sit or stand for long periods of time, occasional stooping, and reaching; May require lifting up to 25 pounds; Requires a normal range of vision and hearing with or without accommodations; Position is not substantially exposed to adverse environmental conditions.