DRG Revenue Integrity Auditor - Full Time
At CorroHealth our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable for achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success. Location: Remote within US only Job Summary: The Inpatient Auditing Specialist performs Diagnostic Related Group (DRG) validation and quality audits on Inpatient. The Coding Quality Expert will perform the chart reviews in collaboration with and alongside fellow team members consisting of Physician Reviewer. This team is referred to as The Tower. Job Description: The Tower will utilize International Classification of Diseases and Physicians Current Procedural Terminology to ensure accurate coding. They will support CorroHealth in denial reviews, In Patient, CDI, Pro Fee, and Milliman Care and InterQual guidelines.
- Responsible for validating proper sequencing and accuracy of ICD-10-CM/PCS codes, POA assignments, and other coding factors.
- Usage of most current Clinical Criteria, MCG, InterQual, payers’ Clinical Policy Bulletins, CMS Guidelines, NCDs and/or LCDs
- Maintaining compliance in turnaround time requirements as mandated by the TAT Standards of the facility and/or CorroHealth standards
- Support CorroHealth in developing accurate training materials
- Provide training within the tower to team members and to new hires
- Assist CorroHealth with project data analysis, reporting, and feedback internally and externally to CorroHealth clients
- Maintain professional etiquette within The Tower
- Works directly with clients, CDI Specialist, MD Physician Reviewers and CorroHealth Leadership
- Ensures all PHI is appropriately stored and delivered to authorized individuals
- Meets or exceeds production and quality metrics
- Attend all mandatory meetings and trainings
- All other position related duties as delegated by management
Experience/Skills/Certification Requirements:
- Must have a CCS, credential, from AHIMA
- RNs must have a CCDS certification from ACDIS or CDIP certification from AHIMA
- Knowledge of CMS, State Regulations, ICD-10-CM/PCS, CPT, and Coding Clinic Guidelines
- Experience in computer skills, Word, Excel, Outlook, experience working in a health plan medical management documentation system a plus.
- CDI experience, inpatient coding experience, inpatient facility coding,
- 3-5 years minimum, DRG Validation Auditing experience
- Need to be a strong Inpatient FAC coder and have experience with DRG coding and audits
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The list below is representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Job Type: Full-time Pay: $90,000.00 - $115,000.00 per year Benefits:
- 401(k) matching
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
License/Certification:
- CCS (Required)
- CCDS or CDIP (Preferred)
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