Job Description
- Job Description:
- 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
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