CERIS · 2 months ago
Clinical Review Auditor
United States
Full-time
Remote
Mid Level
$69K/yr - $105K/yrCERIS, a division of CorVel Corporation, is dedicated to accuracy and transparency in healthcare payments. The Diagnostic Related Groups (DRG) Clinical Auditor will perform validation reviews of medical records, ensuring accurate coding and compliance with regulations, while providing clinical support and documentation of findings.
Health CareMedicalPayments
Responsibilities
The Clinical Auditor will review medical records to determine accuracy of billing through verification of coding and review of supporting clinical documentation
Conduct audits to ensure accurate reimbursement and identifying potential savings
Demonstrated knowledge of ICD-10-CM codes, PCS and DRG coding, understanding of payer rules and regulations, including Medicare and Medicaid
Understand and comply with all internal and external policies
Working knowledge of HIPAA Privacy and Security Rules
Assist Quality Control team and medical director with appeals, rebuttals, etc
Notify leadership of any issues or concerns in a timely manner
Additional duties as assigned
Qualification
Required
CCS or CIC required with DRG auditing experience in ICD-10-CM, ICD-10 PCS
Demonstrated knowledge of ICD-10-CM codes, PCS and DRG coding, understanding of payer rules and regulations, including Medicare and Medicaid
Understand and comply with all internal and external policies
Working knowledge of HIPAA Privacy and Security Rules
Assist Quality Control team and medical director with appeals, rebuttals, etc
Notify leadership of any issues or concerns in a timely manner
Proficient understanding of Medicare, CMS guidelines and ICD-10 coding guidelines
Effective and professional communication skills, both verbal and written
Ability to work independently and in a team environment
High attention to detail
Must possess critical thinking skills
Ability to multi-task and assist with team coverage and provide support when needed
Ability to build relationships both internally and externally
Ability to work in a fast-paced environment
Demonstrated proficiency in basic computer skills and typing
Proficiency with Microsoft Office
Preferred
LVN or RN license in the state of employment preferred
Experience in the OR, ICU, or ER as an RN highly preferred
Benefits
Medical (HDHP) w/Pharmacy
Dental
Vision
Long Term Disability
Health Savings Account
Flexible Spending Account Options
Life Insurance
Accident Insurance
Critical Illness Insurance
Pre-paid Legal Insurance
Parking and Transit FSA accounts
401K
ROTH 401K
Paid time off
Company
CERIS
CERiS is a company that detects and resolves payment issues for health claims.
Founded in 1990
501-1000 employees
Funding
Current Stage
Late StageRecent News
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