Clinical Review Auditor

CorVel • Benbrook, TX

91d • $68,566 - $104,814 • Remote

About The Position

The Diagnostic Related Groups (DRG) Clinical Auditor will be responsible for performing DRG validation (clinical/coding) reviews of medical records and/or other documentation to determine correct DRG/coding and clinically supported as defined by review methodologies specific to the type of review. This involves completing medical records review, accurately documenting findings and non-findings and providing clinical/policy/regulatory support for the determination. Experience using ICD-10-CM & PCS coding guidelines, the ability to understand modern pharmacology, disease management and clinical intervention procedures. The ideal DRG Clinical Auditor candidate will have strong oral and written communication skills, clinical knowledge of disease process, and knowledge of medical necessity rules. This is a remote position.

Requirements

• Current LVN or RN license in the state of employment.
• Current license must be maintained during employment.
• CCS or CIC required with DRG auditing experience in ICD-10-CM, ICD-10 PCS.
• Experience in the OR, ICU, or ER as an RN highly preferred.
• Extreme attention to detail.
• Must possess critical thinking skills.

Nice To Haves

• Proficient in Medicare, CMS guidelines and ICD-10 coding guidelines.
• Effective and professional communication skills, both verbal and written.
• Ability to think and work independently, while working in an overall team environment.
• Ability to work in a fast-paced environment.
• Proficient in Microsoft Office Suite.

Responsibilities

• Review medical records to determine accuracy of billing through verification of coding and supporting clinical documentation.
• Conduct audits to ensure accurate reimbursement and identifying potential savings.
• Demonstrate knowledge of ICD-10-CM codes, PCS and DRG coding, understanding of payer rules and regulations, including Medicare and Medicaid.
• Work independently with minimal supervision and demonstrate initiative.
• Communicate clearly and accurately.
• Understand and comply with all internal and external policies.
• Assist Quality Control team and medical director with Appeals, Rebuttals, etc.
• Notify manager/leadership of any issues or concerns in a timely manner.
• Perform additional duties as assigned by leadership.

Benefits

• Medical (HDHP) w/Pharmacy
• Dental
• Vision
• Long Term Disability
• Health Savings Account
• Flexible Spending Account Options
• Life Insurance
• Accident Insurance
• Critical Illness Insurance
• Pre-paid Legal Insurance
• Parking and Transit FSA accounts
• 401K
• ROTH 401K
• Paid time off

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Professional, Scientific, and Technical Services
• Education Level: Bachelor's degree