Nurse Coder DRG Auditor I
T
Trend Health PartnersPayment Integrity
United StatesFull-TimeMiddle
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.
- Coding certification in good standing (e.g., CCS, CIC).
- Proven clinical practice experience.
- Proven coding validation or auditing experience.
- Well-developed verbal and written communication skills.
- Strong organizational skills and ability to prioritize tasks.
- Proficiency with Microsoft Office, specifically Excel.
Responsibilities
- Utilize coding and clinical guidelines to perform DRG or APC validation.
- Validate principal and secondary diagnoses, sequencing, discharge status, and procedures using medical records.
- Evaluate short stay claims for medical necessity of an inpatient level of care.
- Apply CPT and ICD-10 guidelines and adhere to CMS, commercial payer, InterQual, and MCG standards.
- Provide appeal responses for claims based on industry standards and company policies.
- Assist with new concept development, claim selection criteria, and itemized bill review.
- Maintain all required licensures, certifications, and continuing education requirements.
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