5 drg validation coding auditor jobs found

Clinical Coding Auditor & Trainer Location: Remote (U.S.) Must be willing to travel to New York twice annually Position Type: Full Time The Clinical Coding Auditor & Trainer is responsible for conducting clinical documentation and coding audits to ensure compliance with federal regulations, payer requirements, and company policies. This position focuses on DRG validation, inpatient...

Must Haves 2+ 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. Expert coding knowledge (DRG & ICD-10) Registered Nurse RN (must be inpatient) WITH coding/clinical documentation certification (2 years in clinical documentation) Day to Day Insight Global is seeking a DRG Validation Auditor for one of our clients to sit 100% remote. This person should have an extensive background in either facility-based nursing, clinical documentation, and/or inpatient coding and has a high level of understanding of reimbursement guidelines specifically an understanding of the MS-DRG, AP-DRG, and APR-DRG payment systems. This position is responsible for auditing inpatient medical records and generating high-quality recoverable claims for the benefit of our client and their clients. They are responsible for...

Req Number 177189 Job Description Validates Acute Inpatient coded charts to ensure the diagnostic information leading to the assignment can be substantiated by the documentation in the Medical Record. Job Responsibilities 1.Leverages clinical expertise to identify and validate DRG code assignment. 2.Full review of CDI suggested code changes 3.Demonstrates comprehensive knowledge of coding guidelines and principals; performs coding audits for optimization. 4.Audits and reviews Medicare/non-Medicare charts to ensure that proper standards are maintained in compliance with Federal and State regulations. 5.Applies coding rules and regulations to the validation review process. 6.Reviews codes on Medicare/non-Medicare charts for compliance to rules and conventions. 7.Communicates DRG changes and rationale to the coding and CDI staff. 8.Identifies appropriate coding changes necessary to provide the most valid documentation in compliance with Federal and State...

Req Number 176729 Job Description Validates Acute Inpatient coded charts to ensure the diagnostic information leading to the assignment can be substantiated by the documentation in the Medical Record. Seeking RN candidates with a HCS-D - Home Care Coding Specialist-Diagnosis, COS-C Certificate for OASIS Specialist-Clinical. Remote position Job Responsibility 1.Leverages clinical expertise to identify and validate DRG code assignment. 2.Full review of CDI suggested code changes 3.Demonstrates comprehensive knowledge of coding guidelines and principals; performs coding audits for optimization. 4.Audits and reviews Medicare/non-Medicare charts to ensure that proper standards are maintained in compliance with Federal and State regulations. 5.Applies coding rules and regulations to the validation review process. 6.Reviews codes on Medicare/non-Medicare charts for compliance to rules and conventions. 7.Communicates DRG changes and rationale to the coding and CDI...

P osition Summary : Responsible for performing formal root cause and trend analyses of exceptions escalated from ConServe's monitoring and all other consumer-facing business activities, including consumer complaints and issues escalated to Corporate Compliance from various input channels. Responsible for performing targeted audits (control evaluations) to assess the quality and effectiveness of an individual control, a group of controls, or an entire process. Responsible for our PPMS (Professional Practices Management System) audits as well as our FISMA (Federal Information Security Management Act) audits. The Corporate Compliance Auditor is responsible for performing independent investigation on consumer complaints and issues escalated to Corporate Compliance from various input channels. The Corporate Compliance Auditor will perform Compliance Monitoring activities as assigned that ensure consumer financial regulations, Client, and ConServe's requirements are...