CERIS Health

CERIS, a division of CorVel, seeks a DRG Clinical Auditor to perform DRG validation reviews, determine correct coding, and document findings. The role requires ICD-10-CM/PCS proficiency, clinical knowledge, and familiarity with medical necessity rules. The position emphasizes independent work, strong communication, and adherence to payer regulations, HIPAA, and internal policies in a fast-paced healthcare environment. #J-18808-Ljbffr

CERIS Certified Coder The CERIS Certified Coder reverse codes previously coded medical bills to determine coding accuracy. This role is responsible for making claim-related recommendations and communicating status of the claim to involved stakeholders. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives claim and processes based on state rules and regulations Determines validity and compensability of the claim using CorVel proprietary programs Makes recommendations and communicates claim status to referring office Read and comprehend all medical reports Adhere to client and carrier guidelines and participate in claims review as needed Assists other claims professionals with more complex or problematic claims as necessary Maintain HIPAA compliance Additional duties as assigned KNOWLEDGE & SKILLS: Ability to learn rapidly to develop knowledge and understanding of claims practices Strong organizational skills Ability to...

Ceris Certified Coder ICeris is seeking a Certified Coder. The Ceris Certified Coder reverse codes previously coded medical bills to determine coding accuracy. This is a remote role.Essential Functions & Responsibilities:Receives claim and processes based on state rules and regulationsDetermines validity and compensability of the claim using CorVel proprietary programsMakes recommendations to referring officeCommunicates claim status with referring officeReads and comprehends all medical reportsAdheres to client and carrier guidelines and participates in claims review as neededAssists other claims professionals with more complex or problematic claims as necessaryAdditional duties/responsibilities as assignedComplies with all safety rules/regulations, in conjunction with the Injury and Illness Prevention Program (IIPP), as well as, maintains HIPAA complianceKnowledge & Skills:Ability to learn rapidly to develop knowledge and understanding of claims practiceStrong...