DRG Claims Auditor, Recoveries - Remote

Overview

The DRG Claims Auditor role involves validating and auditing claims with a focus on coding expertise and adherence to medical and reimbursement policies. This position is integral to identifying inaccurately paid claims and ensuring compliance with relevant guidelines.

In Short

• Perform DRG validation and quality audits on claims.
• Provide coding expertise in the claim adjudication process.
• Identify overpayment opportunities through detailed analysis.
• Utilize knowledge of ICD-10 and reimbursement guidelines.
• Maintain high-quality standards in a fast-paced environment.
• Collaborate with various stakeholders to resolve claims issues.
• Document audits and provide analytical data on billing trends.
• Stay updated on coding guidelines and reimbursement trends.
• Communicate effectively across multiple channels.
• Work remotely with a focus on quality and compliance.

Requirements

• Associate’s degree required; Bachelor’s preferred.
• 3-5 years of related experience in claims auditing.
• Certification in coding (CIC, CPC, CCS, RHIT) required.
• Thorough knowledge of ICD-10, CPT, and revenue codes.
• Strong analytical and quantitative skills.
• Excellent communication and project management skills.
• Ability to work in a high-volume production environment.
• Familiarity with financial services regulations.
• Strong work ethic and attention to detail.
• Ability to influence and communicate effectively.

Benefits

• Work remotely from most US states.
• Competitive salary with growth opportunities.
• Comprehensive health benefits.
• Supportive team environment.
• Professional development opportunities.
• Flexible work hours.
• Engagement in impactful healthcare initiatives.
• Access to a wide network of professionals.
• Commitment to diversity and inclusion.
• Employee assistance programs.