Inpatient Claims Auditor | Medical Coding
M
MachinifyHealthcare intelligence
Work from anywhere in the US!Full-TimeMiddle
Salary90000 - 115000 USD per year
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Job Details
- Experience
- 2 years or more
- Required Skills
- HIPAA
Requirements
- An associate or bachelor’s degree in nursing (active/unrestricted license); or in health information management is required.
- RHIA - Registered Health Information Administrator (required)
- RHIT- Registered Health Information Technician (required)
- CCDS - Certified Clinical Documentation Specialist (required)
- CDIP - Clinical Documentation Improvement Practitioner (required)
- CCS - Certified Coding Specialist (required)
- CIC - Certified Inpatient Coder (required)
- Inpatient claims auditing, quality assurance or recovery auditing experience of 2 years or more required
- Inpatient Clinical Documentation Integrity experience of 2 years or more required
- Strong focus on quality and attention to detail.
- Deep curiosity and analytical skills to understand root causes of events and behaviors.
- Proven ability to apply critical judgment in clinical and coding determinations.
- In-depth knowledge of clinical criteria and documentation requirements to support code assignments.
- Expert in DRG methodologies (e.g., MS & APR).
- Expertise in ICD-10-CM/PCS coding, UHDDS definitions, Official Coding Guidelines, and AHA’s Coding Clinic Guidelines.
- Ability to work independently and efficiently with minimal supervision.
Responsibilities
- Conduct thorough DRG payment validation reviews, including clinical and coding assessments, of medical records and related documentation in accordance with contract-specific review criteria.
- Meticulously document findings, provide detailed clinical, policy, and regulatory support and collaborate with relevant stakeholders to ensure compliance with payment standards.
- Audit patient medical records using clinical, coding, and payer guidelines to ensure accurate reimbursement.
- Provide clear, evidence-based rationale for code recommendations or reconsiderations to providers or payers.
- Collaborate with team leaders to ensure thorough review of DRG denials.
- Conduct audits in alignment with organizational quality and timeliness standards.
- Use proprietary auditing systems proficiently to make consistent determinations and generate audit letters.
- Recommend improvements to the audit system to enhance efficiency.
- Ensure compliance with HIPAA regulations for protected health information.
- Perform other duties as assigned.
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