Nurse Coder, DRG Auditor I

Role Overview

• Review medical records and associated claim information to validate accuracy of DRG assignments, APC assignments and/or medical necessity for inpatient level of care
• Apply coding and clinical principles based on industry standards and company/client guidelines
• Utilize coding guidelines and clinical guidelines to perform DRG or APC validation
• Validate principal diagnosis, secondary diagnoses, sequencing of diagnoses, discharge statuses and procedures utilizing the medical record
• Evaluate short stay claims for medical necessity of an inpatient level of care
• Apply CPT and ICD-10 guidelines
• Apply policies, procedures, guidelines and regulations developed by Centers for Medicare and Medicaid Services (CMS), commercial payers, InterQual, MCG, and Trend Health Partners

Requirements

• An active RN professional license in good standing
• Clinical practice experience
• Coding certification in good standing. Examples: CCS, CPC, CIC
• Coding validation/auditing experience
• Well-developed verbal and written communication skills coupled with recognizable organization
• Ability to effectively prioritize tasks
• Microsoft Office experience, specifically Excel

Benefits

• Competitive salaries
• Highly valued health insurance
• 401(k) plan with employer match
• Paid parental leave
• Professional development opportunities