DRG Validation Auditor
New
C
Clover HealthHealth insurance
Remote - USAFull-TimeJunior
Salary76,000 - 99,000 USD per year
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Job Details
- Experience
- At least 1 year of direct inpatient clinical coding experience
- Required Skills
- Microsoft ExcelPowerPoint
Requirements
- Hold a CCS or CIC certification; required.
- Have knowledge of DRG pricing methodology; required.
- Have at least 1 year of direct inpatient clinical coding experience.
- Medicare or Medicare Advantage payment integrity or claims operations experience is preferred.
- Have strong computer skills in Excel and PowerPoint.
Responsibilities
- Partner with Clinical, Claims, and Payment Integrity peers to review claims for DRG-related issues prospectively and retrospectively.
- Identify overpayments to support accurate claims payments on inpatient services.
- Participate in discussions with MDs to verify the clinical rationale behind billed procedures.
- Communicate across multidisciplinary teams to build working partnerships.
- Communicate internally and externally to support accurate claims adjudication and proper provider notification.
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