CERIS · 5 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 DRG Clinical Auditor will perform DRG validation reviews of medical records to ensure correct coding and provide clinical support, while demonstrating strong communication skills and clinical knowledge.
Health CareMedicalPayments
Responsibilities
The Clinical Auditor will review medical records to determine accuracy of billing through verification of coding and supporting clinical documentation
Conducting 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
The ability to work independently with minimal supervision and demonstrate initiative
Able to communicate clearly and accurately
Clearly understands and comply with all internal and external policies
Working knowledge of HIPAA Privacy and Security Rules
Ability to multi-task and assist with team coverage and provide support when needed
Ability to build relationships both internally and externally
Assists Quality Control team and medical director with Appeals, Rebuttals, etc
Demonstrated proficiency in basic computer skills and typing, i.e., Microsoft Windows, Outlook, Word, PowerPoint, Internet Explorer, etc
Notify manager/leadership of any issues or concerns in a timely manner
Additional duties as assigned by leadership
Qualification
Required
Current LVN or RN license in the state of employment
Current license must be maintained during employment
CCS or CIC required with DRG auditing experience in ICD-10-CM, ICD-10 PCS
Experience using ICD-10-CM & PCS coding guidelines
Strong oral and written communication skills
Clinical knowledge of disease process
Knowledge of medical necessity rules
Demonstrated knowledge of ICD-10-CM codes, PCS and DRG coding
Understanding of payer rules and regulations, including Medicare and Medicaid
Ability to work independently with minimal supervision and demonstrate initiative
Able to communicate clearly and accurately
Clearly understands and comply with all internal and external policies
Working knowledge of HIPAA Privacy and Security Rules
Ability to multi-task and assist with team coverage and provide support when needed
Ability to build relationships both internally and externally
Assists Quality Control team and medical director with Appeals, Rebuttals, etc
Demonstrated proficiency in basic computer skills and typing, i.e., Microsoft Windows, Outlook, Word, PowerPoint, Internet Explorer, etc
Notify manager/leadership of any issues or concerns in a timely manner
Extreme attention to detail
Must possess critical thinking skills
Proficient in Medicare, CMS guidelines and ICD-10 coding guidelines
Effective and professional communication skills, both verbal and written
Ability to think and work independently, while working in an overall team environment
Ability to work in a fast-paced environment
Proficient in Microsoft Office Suite
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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