Jobs

Description

Open to FT Remote position

Must be available Monday - Friday, Eastern time (ET).

Job Summary:

• This position is responsible for reviewing clinical records to ensure appropriate billing practices utilizing industry standard coding resources.
• Review requires the use of critical thinking and clinical judgment to make a clinical/coding determination for an individual case.
• The expectation and outcome from the review process is quality improvement and plan development recommendations.
• Review will be inclusive of but not limited to DRG and clinical validation reviews.
• Requires a current working knowledge of ICD-10 coding principles, government correct billing and coding regulation and protocols.

Skills and Abilities:

• Demonstrated proficiency in medical record review, chart audits and analysis.
• Demonstrated knowledge of diagnosis related group (DRG) assignments and DRG assignment tools.
• Demonstrated knowledge of CPT/HCPCS, ICD-10-CM and PCS, coding conventions and rules.
• Demonstrated experience with coding and claims processing systems.
• Demonstrated ability to apply critical review judgment to make relevant clinical determinations.

Education:

• Prefers a Bachelor Degree from an accredited college or university.
• Current/Active RN license required.
• Highly desirable CIC, COC, CPMA, CPCO

Experience:

• Requires a minimum of 3 years of acute care inpatient clinical experience.
• Requires 3 years’ of hospital inpatient coding experience using ICD10 diagnosis and procedure coding within the last 2 years.
• Working knowledge of the DRG validation and regulatory requirements.
• Working knowledge of Evidence-based care guidelines/MCG a plus.
• Experience in claims processing and data management.
• Proficient in Excel.