Nurse Coder DRG Auditor I
New
United StatesFull-TimeEntry
Salary85,000 - 90,000 USD per year
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Job Details
- Required Skills
- Microsoft Excel
Requirements
- Active RN professional license in good standing.
- Clinical practice experience.
- Coding certification in good standing (e.g., CCS, CPC, CIC).
- Coding validation/auditing experience.
- Well-developed verbal and written communication skills.
- Strong organizational skills and ability to prioritize tasks.
- Proficiency with Microsoft Office, specifically Excel.
- Maintain licensures, certifications and continuing education requirements.
Responsibilities
- Utilize coding guidelines and clinical guidelines to perform DRG or APC validation.
- Validate principal diagnosis, secondary diagnoses, sequencing of diagnoses, discharge statuses and procedures utilizing the medical record.
- Evaluate short stay claims for medical necessity of an inpatient level of care.
- Apply CPT and ICD-10 guidelines.
- Apply policies, procedures, guidelines and regulations developed by CMS, commercial payers, InterQual, and MCG.
- Provide appeal responses for claims utilizing industry standards and company/client policies.
- Assist with new concept development and claim selection criteria.
- Assist with itemized bill review as needed.
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