DRG Validation and Clinical Claims Reviewers

Job description

***Must be able to commit to 20 hours minimum. Flexible working schedule available.

This list does not represent all responsibilities for this position

• Perform comprehensive DRG and/or clinical validation reviews to determine accuracy of the DRG billed, based on industry standard using ICD10 coding and Clinical guidelines evidenced by supplied medical records.
• Based on the evidence presented in the medical records, determine and record the appropriate (revised) Diagnosis Codes, Procedure Codes and Discharge Status Code applicable to the claim
• Coding Team and Clinical Reviewer Team to communicate and respond to claim inquiries
• Review inquiries to be answered in quick turnaround time determined by Client's expectations
• * Clinical Reviewers-Interact with Coders and assist them when with clinical information when escalated for review

DRG Validator Qualifications and Education Requirements

• Inpatient Coding Certification required (i.e. CCS, CIC, RHIA, RHIT)
• Thorough understanding of the revenue cycle and the various DRG Groupers necessary for case assignments & payor-specific billing/reimbursement

*Below additional credentials a plus

• Registered Nurse with coding certification ( CCS or CIC)
• Physician (MD, DO or FMG)

*Clinical Documentation certification (CDIP, CCDS) a plus

• Skills
• Ability to prioritize and organize workload and complete tasks independently
• Ability to communicate effectively both orally and in writing
• Thorough understanding of the revenue cycle and the various DRG Groupers necessary for case assignments & payor-specific billing/reimbursement
• 3+ years reviewing and/or auditing ICD-10 CM, MS-DRG and APR-DRG claims preferred
• Proficiency in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint), Google Apps and knowledge in the use of intranet and internet applications.
• Experience working in a remote environment
• Excellent Communication skills written and verbal

*This position is for healthcare payer/Insurance claims reviews, may include resolution expertise in complex clinical review cases.

Schedule:

• Monday to Sunday
• Weekend availability

Experience:

• DRG Validation: 3 years (Preferred)

License/Certification:

• CCS, CDIP or CCDS certification (Preferred)

Work Location: Fully Remote

Job Types: Part-time, Contract

Pay: $55.00 - $65.00 per hour

Benefits:

• Flexible schedule

Schedule:

• Day shift
• Evening shift
• Monday to Friday
• Night shift
• Weekends as needed

Work setting:

• Remote

Experience:

• DRG Validation: 3 years (Preferred)

License/Certification:

• CCS, CDIP or CCDS certification (Preferred)

Work Location: Remote