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[Remote] DRG Validation Auditor
Note: The job is a remote job and is open to candidates in USA. ECU Health is a mission-driven, 1,708-bed academic health care system serving more than 1.4 million people in eastern North Carolina. They are seeking a DRG Validation Auditor responsible for ensuring the integrity of inpatient medical records by auditing them to confirm that clinical documentation accurately supports the condition and DRG billed and reimbursed.
Responsibilities
- Analyze and audit claims by integrating medical chart coding principles and guidelines
- Proficiency in DRG assignments, ICD-10 CM, ICD-10-PCS, official coding guidelines, medical terminology, human anatomy and physiology, pathophysiology, pharmacology, and proficiency in Microsoft Office products (Word and Excel)
- Generate audit determinations and compile detailed audit findings letters
- Excellent verbal and written communication skills
- Writes clear, accurate and concise recommendations in support of findings while providing feedback and education to the coders, referencing current ICD-10-CM/PCS Official Coding Guidelines and AHA Coding Clinics
- Ability to work independently and exercise independent judgment
- Critical thinking skills
- Research coding questions asked by coding and other areas in a timely manner
- Must have knowledge of the Clinical Documentation Management Program and assist the Documentation Specialist with questions regarding code/DRG assignment
- Serves as back up for the Coding Specialist II, Coding Specialist III and Coding Auditor when needed
- Make recommendations on coding education and training based on audit results
- Other duties and responsibilities, as assigned
- Maintains AHIMA credentials, CEUs and up to date knowledge of coding guidelines
Skills
- Detailed understanding of medical coding principles, coding guidelines, coding clinics
- Ability to perform objective medical audits
- Advanced ICD-10 coding expertise and guidelines
- Proficiency in DRG assignments, ICD-10 CM, ICD-10-PCS, official coding guidelines, medical terminology, human anatomy and physiology, pathophysiology, pharmacology
- Proficiency in Microsoft Office products (Word and Excel)
- Excellent verbal and written communication skills
- Ability to write clear, accurate and concise recommendations in support of findings
- Ability to provide feedback and education to the coders, referencing current ICD-10-CM/PCS Official Coding Guidelines and AHA Coding Clinics
- Ability to work independently and exercise independent judgment
- Critical thinking skills
- Ability to research coding questions asked by coding and other areas in a timely manner
- Knowledge of the Clinical Documentation Management Program
- Ability to assist the Documentation Specialist with questions regarding code/DRG assignment
- Ability to serve as back up for the Coding Specialist II, Coding Specialist III and Coding Auditor when needed
- Ability to make recommendations on coding education and training based on audit results
- Maintains AHIMA credentials, CEUs and up to date knowledge of coding guidelines
- Associate or Bachelor's degree in AHIMA accredited Health Information Management program with credentialing as a RHIA or RHIT
- AHIMA certified Coding Specialist (CCS) credential may be substituted in lieu of a degree
- 5 years' experience
- Prior coding auditor experience
Benefits
- Great Benefits
Company Overview
