US Tech Solutions

Duration: 5 months (Possible contract to hire) Work Schedule: Monday-Friday, 8am-4:30pm. Job Description: A typical day would like in this role: We are opening these positions due to increased volume of DRG review. We currently have 2 Medical Review Auditors on our team already. The normal day is DRG reviews and audits. Responsibilities: Performs validation reviews of Diagnosis Related Groups (DRG), Adaptive Predictive Coding (APC), and Never Events (inexcusable outcomes in a healthcare setting) for all lines of business. Coordinates rate adjustments with claims areas. Provides monthly and quarterly reports outlining trends. Serves as a resource in resolving coding issues. Coordinates HIPAA and legal records requests for all areas of Healthcare Services and the Legal Department. Determines methodology to identify cases for validation review. Conducts validation reviews/coordinates rates adjustments with appropriate claims area. Creates monthly/quarterly reports to present to each...