Review medical records and associated claim information to validate accuracy of DRG assignments and/or Itemized Billing
Apply coding principles based on industry standards and company/client guidelines
Validate principal diagnosis, secondary diagnoses, sequencing of diagnoses, discharge statuses and procedures utilizing the medical record
Apply policies, procedures, guidelines and regulations developed by Centers for Medicare and Medicaid Services (CMS), commercial payers, InterQual, MCG, and Trend Health Partners
Validate itemized bill payments utilizing the UB-04, the itemized bill and industry/client coding guidelines
Provide appeal responses for claims of the above types utilizing industry standards and company/client policies
Assist with new concept development
Assist with claim selection criteria
Maintain certifications and continuing education requirements
May require client communication to support findings

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

Coder DRG Auditor I

Key skills