Remote RN Auditor / Coder (Coding Cert Required)

Job Overview

  • Specialty License RN
  • State License(s) Nationwide

Remote Clinical Coding and Audit Nurse ( RN ) Needed!

The ideal candidate for this position needs to have both a clinical (RN) and a coding / auditing background that includes writing appeals to health insurance companies on various types of audits that includes Line Item Charge/Outlier Audits, ER Downgrade Audits, DRG Downgrade Audits and Clinical Validation Audits. This position is responsible for auditing outpatient and inpatient claims, documenting the results of those audits with a focus on clinical review, coding accuracy, billing guidelines, medical necessity, and the appropriateness of treatment setting, and services delivered.

Job Description:

  • Experience appealing and defending post-payment DRG Validation Audits, DRG and ER downgrade Audits, Charge/Outlier Audits, etc.
  • Experience providing clinical documentation improvements and provide education to assist hospitals in areas that could be weak when payer’s audits are valid (i.e. Medicare billing guidelines, payer medical policies, physician documentation issues, charge master errors, coding quality issues, etc.)
  • Have extensive knowledge with ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions.
  • Develop reports to measure and monitor productivity, client trends, and overall success rates.
  • Have experience working with payers and building a rapport with provider reps when available.
  • Reviews and interprets medical records and applies in-depth knowledge of coding principles to determine potential billing/coding issues.
  • Have experience using InterQual, MCG guidelines, obtaining and reviewing payer medical policies, and knowledge of CMS and other payers medical billing and coding guidelines.
  • Performs work independently
  • Excellent verbal and written communication skills.
  • 3-5 years managing a team and ability to work well individually and in a team environment.

Requirements:

  • RN License required
  • Coding Certification required and maintained (i.e. CPC, CIC, CCS, RHIA or RHIT)
  • Minimum of 3 years of experience with clinical medical record coding or auditing and a working knowledge of CMS guidelines. (Line Item Charge Audits and DRG Audits preferred)
  • A broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, medical necessity criteria and coding terminology.
  • Adherence to official coding guidelines, coding clinic determinations and CMS and other regulatory compliance guidelines and mandates. Requires expert coding knowledge – DRG, ICD-10, CPT, HCPCS codes.
  • Excellent verbal and written communication skills.
  • Ability to work well in an individual and team environment.
  • This position works from home anywhere in the continental US
  • This role is aligned to certain productivity & quality metrics
  • Ability to travel occasionally when needed

Compensation:

  • Base Pay $30-40/hr depending on experience and national certification
  • Bonuses opportunities
  • Revenue sharing
  • Great benefits

Schedule:

  • Monday to Friday Eastern or Central time zone
  • Full time

Apply today for immediate consideration.

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