Claims Auditor
New
C
Cohere HealthHealthtech
United States; This role is not eligible for hire in: AK, CA, CO, HI, NY, or WA.Full-TimeMiddle
Salary72,000 - 82,000 USD per year
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Job Details
- Experience
- 3+ years
Requirements
- 3+ years experience of performing MS-DRG and ARP-DRG reviews for a Payment Integrity vendor or Payer.
- Advanced expertise in ICD-10-CM/PCS coding.
- Ability to assess complex clinical information, validate diagnosis code assignments, and identify coding errors or upcoding.
- CCS (Certified Coding Specialist) credential.
- RHIA or RHIT credential.
- Associate's Degree in Health Information Management, Nursing, or related field.
- Excellent written and verbal communication skills.
- Strong analytical skills and attention to detail.
- Excellent computer skills and familiarity with a Mac.
- Experience working in a start-up or high-growth company environment.
Responsibilities
- Conduct comprehensive MS-DRG and APR-DRG coding reviews to ensure accuracy in DRG assignment and reimbursement.
- Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications.
- Craft clear, concise, and well-supported audit findings, backed by AHA Coding Clinic Guidelines and ICD-10-CM/PCS regulations.
- Utilize advanced DRG encoder tools to drive efficiency and accuracy in audits.
- Meet or exceed company quality and productivity standards, including strong uphold rates for appeals.
- Stay ahead of industry trends, coding updates, and compliance regulations to maintain expert-level knowledge.
- Adhere to HIPAA and company policies and procedures to ensure data security and regulatory compliance.
- Maintain and apply superior knowledge of changes and updates to coding guidelines, reimbursement trends, and health payment policy language.
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