Trend Health Partners · 1 month ago
Nurse Coder DRG Auditor I (US Remote)
United States
Full-time
Remote
Mid, Senior Level
$85K/yr - $90K/yr
5+ years expTREND Health Partners is a tech-enabled payment integrity company focused on improving access to healthcare through collaboration between payers and providers. The Nurse Coder DRG Auditor I is responsible for reviewing medical records to validate the accuracy of DRG assignments and medical necessity for inpatient care, applying coding and clinical principles according to industry standards.
Health CareHospitalPayments
Responsibilities
Utilize coding guidelines and clinical guidelines to perform DRG validation
Validate principal diagnosis, secondary diagnoses, sequencing of diagnoses, discharge statuses and procedures utilizing the medical record
Evaluate short stay claims for medical necessity of an inpatient level of care
Apply CPT and ICD-10 guidelines
Apply policies, procedures, guidelines and regulations developed by Centers for Medicare and Medicaid Services (CMS), commercial payers, InterQual, MCG, and Trend Health Partners
Provide appeal responses for claims of the above types utilizing industry standards and company/client policies
Assist with new concept development
Assist with claim selection criteria
Assist with itemized bill review as needed
Maintain licensures, certifications and continuing education requirements
May require client communication to support findings
Qualification
Required
An active RN professional license in good standing
5 years of clinical practice
Coding certification in good standing. Examples: CCS, CPC, CIC
2-5 years coding validation/auditing experience
Well-developed verbal and written communication skills coupled with recognizable organization
Ability to effectively prioritize tasks
Microsoft Office experience, specifically Excel
Preferred
Appeals experience a plus
APR-DRG experience a plus
Client communication experience a plus
Concept development experience a plus
Claim selection experience a plus
Experience with machine learning/artificial intelligence a plus
Case Management and/or Utilization Review experience a plus
Clinical Documentation Improvement experience a plus
Itemized bill validation experience a plus
Quality Assurance experience a plus
Management experience a plus
Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) a plus
TruCode/TruBridge, 3M, WebStrat or similar experience a plus
Benefits
Highly valued health insurance
A 401(k) plan with employer match
Paid parental leave
And more
Company
Trend Health Partners
Trend Health Partners is an employee owned company that provides payment accuracy services for people.
201-500 employees
Funding
Current Stage
Growth StageTotal Funding
unknownKey Investors
Lone View Capital
2023-01-09Private Equity
Leadership Team
Sarah Armstrong
Chief Executive Officer
Max Watson
Chief Financial Officer
Recent News
Company data provided by crunchbase