The Diagnostic Related Groups (DRG) Clinical Auditor will be responsible for performing DRG validation (clinical/coding) reviews of medical records and/or other documentation. This role will determine correct DRG/coding as defined by review methodologies specific to the type of review.
Requirements
- Review medical records to determine accuracy of billing through verification of coding and review of supporting clinical documentation
- Conduct audits to ensure accurate reimbursement and identifying potential savings
- Demonstrated knowledge of ICD-10-CM codes, PCS and DRG coding, understanding of payer rules and regulations, including Medicare and Medicaid
- Understand and comply with all internal and external policies
- Working knowledge of HIPAA Privacy and Security Rules
- Assist Quality Control team and medical director with appeals, rebuttals, etc.
- Notify leadership of any issues or concerns in a timely manner
- Additional duties as assigned
Benefits
- Medical (HDHP) w/Pharmacy
- Dental
- Vision
- Long Term Disability
- Health Savings Account
- Flexible Spending Account Options
- Life Insurance
- Accident Insurance
- Critical Illness Insurance
- Pre-paid Legal Insurance
- Parking and Transit FSA accounts
- 401K
- ROTH 401K
- Paid Time Off
