DRG Validation Auditor – Off Hours Work

Job Description:

• Analyzes and Audits Claims
• Integrates medical chart coding principles, clinical guidelines and objectivity in performance of medical audit activities
• Draws on advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions
• Performs work independently
• Effectively Utilizes Audit Tools
• Utilizes Cotiviti proprietary auditing systems with a high level of proficiency to make audit determinations and generate audit letters
• Meets or Exceeds Standards/Guidelines for Productivity
• Maintains production goals set by the audit operations management team
• Meets or Exceeds Standards/Guidelines for Accuracy and Quality
• Identifies New Claim Types
• Suggests and develops high quality, high value concepts and or process improvement tools

Requirements:

• Associate or bachelor’s degree in nursing (active/unrestricted license)
• Associate or bachelor’s degree in Health Information Management (RHIA or RHIT)
• High school diploma or GED plus equivalent experience of 5+ years in claims auditing, ideally in a DRG / Clinical Validation Audit setting or a hospital environment
• Coding/CDI Certification (at least one of the following are required): RHIA or RHIT, CPC, Inpatient Coding Credential – CCS, CIC, CDIP or CCDS
• 5 to 7+ years of working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG with knowledge of medical claims billing/payment systems, provider billing guidelines, payer reimbursement policies, and medical necessity criteria
• Expert coding knowledge - DRG, APRDRG, ICD-10, CPT, HCPCS codes
• Proficiency in Word, Access, Excel, TEAMS, and other applications
• Excellent written and verbal communication skills

Benefits:

• Medical, dental, vision, disability, and life insurance coverage
• 401(k) savings plans
• Paid family leave
• 9 paid holidays per year
• 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti

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