Senior Medical Coder / Auditor - RN

We are hiring for a RN Coding Analyst / Auditor

Job title : Validation RN Auditor

Work type : Contract to hire

Location : FULLY REMOTE

Rate : $55.00 per hour

This job will have the following responsibilities :

Conduct MS-DRG and APR-DRG coding reviews to verify the accuracy of DRG assignment and reimbursement with a focus on overpayment identification

Expert knowledge of and the ability to : identify the ICD-10-CM / PCS code assignment, appropriate code sequencing, present on admission (POA) assignment, and discharge disposition, in accordance with CMS requirements, ICD-10 Official Guidelines for Coding and Reporting, and AHA Coding Clinic guidance

Must be fluent in the application of current ICD-10 Official Coding Guidelines and AHA Coding Clinic citations, in addition to demonstrating working knowledge of clinical criteria documentation requirements used to successfully substantiate code assignments

Perform clinical coding review to ensure accuracy of medical coding and utilizes clinical expertise and judgment to determine correct coding and billing

Solid command of anatomy and physiology, diagnostic procedures, and surgical operations developed from specialized training and extensive experience with ICD-10-PCS code assignment

Writes clear, accurate and concise rationales in support of findings using ICD-10 CM / PCS Official Coding Guidelines, and AHA Coding Clinics

Utilize proprietary workflow systems and encoder tool efficiently and accurately to make audit determinations, generate audit rationales and move claims through workflow process correctly

Qualifications & Requirements :

Unrestricted RN (registered nurse)

CCS / CIC or will obtain within 6 months of hire

3+ years of MS DRG / APR DRG coding experience in a hospital environment with expert knowledge of ICD-10 Official Coding Guidelines and DRG reimbursement methodologies Expert knowledge of ICD-10-CM coding including but not limited to : expert knowledge of principal diagnosis selection, complications / comorbidities (CCs) and major complications / comorbidities (MCCs), and conditions that impact severity of illness (SOI) and risk of mortality (ROM)

Expert knowledge of ICD-10-PCS coding including but not limited to : expert knowledge of the structural components of PCS including but not limited to : selection of appropriate body systems, root operations, body parts, approaches, devices, and qualifiers

Preferred Qualifications :

Experience with prior DRG concurrent and / or retrospective overpayment identification audits

Experience with readmission reviews of claims

Experience with DRG encoder tools (ex. 3M)

Experience using Microsoft Excel with the ability to create / edit spreadsheets, use sort / filter function, and perform data entry

Healthcare claims experience

Managed care experience

Knowledge of health insurance business, industry terminology, and regulatory guidelines

If this interests you, apply today.