DRG Inpatient Coding Validator
New
C
Clover HealthHealth insurance
Remote - USAFull-TimeJunior
Salary$76,000 — $99,000 USD
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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.
- Have knowledge of DRG pricing methodology.
- 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, including Excel and PowerPoint.
Responsibilities
- Review claims prospectively and retrospectively for DRG-related issues with Clinical, Claims, and Payment Integrity peers.
- Identify overpayments on inpatient services to support accurate claims payments.
- Discuss claims with MDs to verify the clinical rationale behind billed procedures.
- Coordinate the identification of provider DRG denials and upcoding.
- Support accurate claims adjudication and proper provider notification through internal and external communication.
- Execute clinical review workflows while maintaining regulatory compliance standards.
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