Nurse Inpatient Coding Auditor, CIC or CCS certified

Job Description

Job Description

Description : Company

ProgenyHealth is a leading provider of care management solutions for premature and medically complex newborns positively impacting maternal and infant health outcomes across America. Our program builds a network of support for an uninterrupted continuum of care from prenatal health, through any resultant NICU stay, and all the way to one full year of life. Our team of neonatologists, pediatricians, and NICU nurses provide continuity of care in collaboration with providers from hospital to caregivers at home and throughout the first year of life. We help overcome systemic barriers to support healthier pregnancies and healthier starts to life for all moms and babies, one family at a time.

Job Role

The Clinical RN Chart Reviewer will perform clinical reviews of medical records and other documentation to validate issues of claims coding accuracy, medical necessity, and the appropriateness of treatment settings and services delivered. The Clinical RN Chart Reviewer will report to the Payment Assurance Manager and support a culture and work environment that promotes and inspires an active, continuous improvement philosophy regarding products and services in line with our company mission.

Requirements :

Responsibilities will include :

• Audits and analyzes neonatal intensive care unit (NICU) claims according to ICD-10 coding principles and clinical guidelines
• Analysis of claims data to optimize reimbursement by ensuring that the diagnosis codes, procedure codes, and supporting documentation accurately support the service rendered.
• Ensures claims analysis complies with ethical coding standards, guidelines, and regulatory requirements
• Responsible for performing clinical reviews of medical records and other documentation to validate issues of claims coding accuracy, medical necessity, and the appropriateness of treatment settings and services delivered
• Research reimbursement regulations for claim payment compliance to support and validate audit findings
• Assist with the development of claims audit process documentation, including workflow diagrams, policies and procedures, and standard operating procedures

Qualifications :

Benefits

Some of the benefits we offer our team are :

ProgenyHealth positively recruits people from diverse backgrounds, including individuals with disabilities - if you need an accommodation to interview, please contact us by email : careers@progenyhealth.com

Equal Opportunity Employer, including individuals with disabilities and veterans.