Auditor Clinical Validation Drg

5-7 years

$44.23 per hour

Remote, USA

10 Aug. 26, 2024

Job Description

Job Type: Full Time Education: B.Pharm/ M.Pharm/ B.Sc/ M.Sc/Any Life Sciences Skills: Causality Assessment, Clinical SAS Programming, Communication Skills, CPC Certified, GCP guidelines, ICD-10 CM Codes, CPT-Codes, HCPCS Codes, ICD-10 CM, CPT, HCPCS Coding, ICH guidelines, ICSR Case Processing, Interpersonal Skill, Labelling Assessment, MedDRA Coding, Medical Billing, Medical Coding, Medical Terminology, Narrative Writing, Research & Development, Technical Skill, Triage of ICSRs, WHO DD Coding

Position Overview

We are seeking a highly skilled professional for a remote auditing role focusing on Coding & Clinical Chart Validation within our Inpatient audit team. The ideal candidate will possess both clinical (nursing) expertise and a solid background in coding and auditing, specifically in Inpatient DRG/APR-DRG. This position involves auditing inpatient claims and documenting audit results with a focus on clinical review, coding accuracy, and the appropriateness of treatment settings and services provided.

Key Responsibilities

Claims Analysis and Auditing: Conduct thorough reviews of inpatient claims, integrating medical chart coding principles and clinical guidelines. Utilize advanced ICD-10 coding knowledge and industry expertise to substantiate audit conclusions. Perform audits independently.
Audit Tools Utilization: Proficiently use Cotiviti's proprietary auditing systems to make audit determinations and generate audit correspondence.
Productivity Standards: Achieve and maintain production goals set by the audit operations management team.
Accuracy and Quality: Meet or exceed accuracy and quality standards for claim identification and documentation, including letter writing.
New Claim Types: Identify potential claims outside of current concepts that may offer additional recoveries. Propose and develop high-value improvements or tools for the auditing process.
Performance and Special Projects: Complete all responsibilities outlined in the annual Performance Plan and undertake special projects or additional duties as assigned. Perform duties with or without reasonable accommodation.

Qualifications

Education:
- Associate or Bachelor’s degree in Nursing (active/unrestricted license)
- Associate or Bachelor’s degree in Health Information Management (RHIA or RHIT)
Certification:
- Required: RHIA or RHIT, CPC, or an Inpatient Coding Credential (CCS, CIC, CDIP, or CCDS)
Experience:
- 5 to 7+ years working with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG.
- Broad knowledge of medical claims billing/payment systems, provider billing guidelines, payer reimbursement policies, and medical necessity criteria.
- Expertise in DRG, APR-DRG, ICD-10, CPT, and HCPCS coding, with adherence to official coding guidelines, coding clinic determinations, and regulatory compliance.
Skills:
- Proficient in Word, Access, Excel, TEAMS, and other applications.
- Excellent written and verbal communication skills.
Mental Requirements:
- Effective communication for information exchange.
- Accurate assessment of work accuracy, neatness, and thoroughness.
Physical Requirements:
- Ability to remain stationary for extended periods.
- Capability to perform repetitive motions involving wrists, hands, or fingers.
- Provision of a dedicated, secure workspace with high-speed internet access and proper office setup.

Compensation and Benefits

Base Compensation: $44.23 per hour (approximately $92,000 annually). Eligible for discretionary bonus consideration.
Benefits Package: Cotiviti offers a competitive benefits package, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on service level.

Application Details

Posting Date: 08/02/2024
Application Deadline: Anticipated to close on 10/02/2024, though the window may close earlier if a suitable candidate is identified.

Equal Employment Opportunity

Cotiviti is an equal employment opportunity employer. We value diversity and make hiring decisions based on qualifications, without regard to race, color, creed, sex, age, religion, pregnancy, national origin, sexual orientation, marital status, genetic carrier status, military service, veteran status, disability, or any other category protected by federal, state, or local laws. All employment decisions are made in accordance with equal employment opportunity principles.

Pay Transparency Nondiscrimination Provision

Cotiviti will not discriminate against employees or applicants for discussing or disclosing their pay or the pay of others. Employees with access to compensation information as part of their job functions are restricted from disclosing this information, except in specific circumstances such as formal complaints, investigations, or legal obligations.

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