Nurse Coder, DRG Auditor I
Employment Information
Job Description
Nurse Coder DRG Auditor reviewing medical records to validate DRG assignments. Joining TREND Health Partners means being part of a tech-enabled payment integrity company dedicated to healthcare access.
Responsibilities:
- review medical records and associated claim information to validate accuracy of DRG assignments and/or medical necessity for inpatient level of care
- Utilize coding guidelines and clinical guidelines to perform DRG 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
- 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
- Assist with itemized bill review as needed
- Maintain licensures, certifications and continuing education requirements
- May require client communication to support findings
Requirements:
- An active RN professional license in good standing
- 5 years of clinical practice
- Coding certification in good standing. Examples: CCS, CPC, CIC
- 2-5 years 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
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