Job Information
COTIVITI, INC. Auditor Clinical Validation DRG in SOUTH JORDAN, Utah
Auditor Clinical Validation DRG Job Locations
US-Remote ID
2024-13201
Category Audit - Healthcare
Position Type Full-Time Overview
This auditing role will focus on Coding and Clinical Chart Validation for our Inpatient audits. The ideal candidate for this position needs to have both a clinical (nurse) and a coding / auditing background focused on the following disciplines from a coding and billing perspective: Inpatient DRG/APR-DRG. This position is responsible for auditing inpatient claims and documenting the results of those audits, with a focus on clinical review, coding accuracy, and the appropriateness of treatment setting and services delivered.
Responsibilities
Analyzes and Audits Claims. Integrates medical chart coding principles, clinical guidelines and objectivity in performance of medical audit activities. Draws on advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions. Performs work independently. * Effectively Utilizes Audit Tools. Utilizes Cotiviti proprietary auditing systems with a high level of proficiency to make audit determinations and generate audit letters. * Meets or Exceeds Standards/Guidelines for Productivity. Maintains production goals set by the audit operations management team. * Meets or Exceed Standards/Guidelines for Accuracy and Quality. Achieves the expected level of accuracy and quality set by the audit for the auditing concept, for valid claim * identification and documentation (letter writing). Identifies New Claim Types. Identifies potential claims outside of the concept where additional recoveries may be available. Suggests and develops high quality, high value concept and or process improvement, tools, etc. * Complete all responsibilities as outlined on annual Performance Plan. * Complete all special projects and other duties as assigned. * Must be able to perform duties with or without reasonable accommodation. * Complete all responsibilities as outlined on annual Performance Plan. * Complete all special projects and other duties as assigned. * Must be able to perform duties with or without reasonable accommodation.
Qualifications
Education (at least one of the following are required): * Associate or bachelor's degree in nursing (active /unrestricted license). * Associate or bachelor's degree Health Information Management (RHIA or RHIT) Coding/CDI Certification (at least one of the following are required and are to be maintained as a condition of employment): * RHIA or RHIT * CPC * Inpatient Coding Credential - CCS, CIC, CDIP or CCDS Experience (required): * 5 to 7+ years of working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG with a broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, medical necessity criteria and coding terminology. * Adherence to official coding guidelines, coding clinic determinations and CMS and other regulatory compliance guidelines and mandates. Requires expert coding knowledge - DRG, APRDRG, ICD-10, CPT, HCPCS codes. * Requires working knowledge of and applicable industry-based standards. * Proficiency in Word, Access, Excel, TEAMS, and other applications. * Excellent written and verbal communication skills. Mental Requirements: * Communicating with others to exchange information. * Assessing the accuracy, neatness, and thoroughness of the work assigned. Physical Requirements and Working Conditions: * Remaining in a stationary position, often standing or sitting for prolonged periods. * Repeating motions that may include the wrists, hands, and/or fingers. * Must be able to provide a dedicated, secure work area. * Must be a ble to provide high-speed internet... For full info follow application link.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
