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The Judge Group · 3 weeks ago

RN DRG Coding Auditor

United States

Contract

Remote

Mid Level

$55/hr - $55/hr

3+ years exp

The Judge Group is hiring for RN's with DRG Auditing experience. This role involves conducting coding reviews to ensure the accuracy of DRG assignments and reimbursement, utilizing expert knowledge of ICD-10 coding guidelines.

E-LearningInformation TechnologyProfessional Services

Hiring Manager

Mark Bondi

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

Qualification

RN licenseCCS/CIC certificationMS DRG/APR DRG codingICD-10-CM codingICD-10-PCS codingDRG reimbursement methodologiesClinical coding reviewAnatomyPhysiology knowledgeDRG encoder toolsMicrosoft ExcelHealthcare claims experienceManaged care experienceHealth insurance knowledge

Required

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