Inpatient Claims Auditor | Medical Coding - Remote

Overview

As part of the Complex Payment Solutions Team, you will, as a DRG Reviewer, be a key contributor responsible for conducting thorough DRG payment validation reviews, including clinical and coding assessments, of medical records and related documentation in accordance with contract-specific review criteria.

In Short

• Audit patient medical records using clinical, coding, and payer guidelines to ensure accurate reimbursement.
• Provide clear, evidence-based rationale for code recommendations or reconsiderations to providers or payers.
• Collaborate with team leaders to ensure thorough review of DRG denials.
• Conduct audits in alignment with organizational quality and timeliness standards.
• Use proprietary auditing systems proficiently to make consistent determinations and generate audit letters.
• Recommend improvements to the audit system to enhance efficiency.
• Ensure compliance with HIPAA regulations for protected health information.
• Perform other duties as assigned.

Requirements

• An associate or bachelor’s degree in nursing (active/unrestricted license); or in health information management is required.
• Work experience may be considered in lieu of formal education at leadership discretion.
• Inpatient claims auditing, quality assurance or recovery auditing experience of 2 years or more required.
• Strong focus on quality and attention to detail.
• Deep curiosity and analytical skills to understand root causes of events and behaviors.
• Proven ability to apply critical judgment in clinical and coding determinations.
• In-depth knowledge of clinical criteria and documentation requirements to support code assignments.
• Ability to work independently and efficiently with minimal supervision.

Benefits

• Work from anywhere in the US!
• Top Medical/Dental/Vision offerings.
• FSA/HSA.
• Tuition reimbursement.
• Competitive salary, 401(k) with company match.
• PTO.
• Additional health and wellness benefits and perks.
• Flexible and trusting environment where you’ll feel empowered to do your best work.