Remote DRG Validator

Overview:

• 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 knowledgeable 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
• 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
• Demonstrate knowledge of and compliance with changes and updates to coding guidelines, reimbursement trends, and client processes and requirements
• Maintain and manages daily case review assignments, with a high emphasis on quality

3-5 Must Have Skills/Qualifications:

• High School Diploma or equivalent, Bachelor's degree preferred.
• Certified Coding Specialist (CCS)
• 3 years of acute care hospital inpatient coding and DRG analysis experience

Monday-Friday (Day shift - flexible)