Remote Clinical Claim Review RN

A company is looking for a Sr. Clinical Claim Review RN.

Key Responsibilities

Conduct MS-DRG and APR-DRG coding reviews to verify accuracy and identify overpayments

Perform clinical coding reviews ensuring accuracy and compliance with coding guidelines

Utilize proprietary workflow systems to manage daily case reviews and audit determinations

Required Qualifications

Unrestricted RN (registered nurse) license

CCS / CIC certification

3+ years of MS DRG / APR DRG coding experience in a hospital environment

Expert knowledge of ICD-10 Official Coding Guidelines and DRG reimbursement methodologies

Expert knowledge of ICD-10-CM and ICD-10-PCS coding components