What are the responsibilities and job description for the DRG Nurse Auditor position at Atlantic Region CBO?
In 2024, UHS was recognized By Newsweek and Plant-A Insights Group; Universal Health Services (NYSE: UHS) announced today that it has been recognized as one of America’s Greatest Workplaces for Diversity 2024 by Newsweek and Plant-A Insights Group. UHS has been growing steadily since our inception into an esteemed Fortune 500 corporation, our annual revenues during 2022 were approximately $13.4 billion. In 2023, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; ranked #311 on the Fortune 500; and ranked #434 among U.S. companies on Forbes Global 2000 World’s Largest Public Companies.
Our operating philosophy is as effective today as it was upon the Company’s founding in 1979: Build or acquire high quality hospitals in rapidly growing markets, invest in the people and equipment needed to allow each facility to thrive, and become the leading healthcare provider in each community we serve. UHS has approximately 94,000 employees and through its subsidiaries operates 27 inpatient acute care hospitals, 331 inpatient behavioral health facilities, nearly 40 outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located in 39 U.S. states, Washington, D.C., Puerto Rico and the United Kingdom.
The Atlantic Region CBO is seeking a dynamic and talented DRG Nurse Auditor with clinical case management experience to be responsible for analyzing clinical claim denials, drafting detailed appeal letters, evaluating clinical level of care, and the review of denial trends.
Key Responsibilities include:
- Perform DRG (Diagnosis Related Group) validation reviews in response to audits from third party payers.
- Review audit findings letters from third party payers to obtain a clear understanding of audited diagnosis codes and underlying payer clinical/coding rationale.
- Analyze medical records to obtain supporting clinical documentation for billed diagnosis codes.
- Communicate findings to third party payers in detailed appeal letters to prevent downgrade payment recoveries.
- Make decisions to update DRGs or remove or add to billed diagnose codes based on clinical reviews.
- Call third party payers and physician offices as needed to obtain additional clinical details.
- Identify audit trends and provide feedback to management and to UHS acute care facilities.
- Adherence to all applicable laws, regulations and guidelines.
- Other duties as assigned.
Qualifications:
- RN or LPN licensure in good standing is required. BSN degree preferred
- Three to five years of experience is preferred
- Working knowledge of coding regulations including ICD-10, DRGs, and HCPCs.
- CPC, CCS or other coding credentials preferred, but not required
- CDI Experience is preferred.
- CCDS certification is preferred.
- Experience working in Patient Financial Services and an understanding of the Revenue Cycle from beginning to end is preferred.
- Experience working in case management or audit with technical denials is preferred.
- Strong Microsoft Office skills (Excel, Word, Outlook)
- Customer focused both internally and externally, strong attention to detail, the ability to multi-task.
- Excellent written and oral communication skills are required.
This opportunity provides the following:
- Challenging and rewarding work environment
- Growth and development opportunities within UHS and its subsidiaries
- Competitive Compensation Excellent Medical, Dental, Vision and Prescription Drug Plan 401k plan with company match
- Generous Paid Time Off
If you meet the above requirements and are looking for a rewarding career, please take a moment to share your background with us by applying online. UHS offers competitive compensation commensurate with experience and benefits programs including medical, dental, life insurance and 401k. UHS is not accepting unsolicited assistance from search firms for this employment opportunity. Please, no phone calls or emails. All resumes submitted by search firms to any employee at UHS via-email, the Internet or in any form and/or method without a valid written search agreement in place for this position will be deemed the sole property of UHS. No fee will be paid in the event the candidate is hired by UHS as a result of the referral or through other means. UHS is a registered trademark of UHS of Delaware, Inc., the management company for Universal Health Services, Inc. and a wholly-owned subsidiary of Universal Health Services, Inc. Universal Health Services, Inc. is a holding company and operates through its subsidiaries including its management company, UHS of Delaware, Inc. All healthcare and management operations are conducted by subsidiaries of Universal Health Services, Inc. To the extent any reference to "UHS or UHS facilities" on this website including any statements, articles or other publications contained herein relates to our healthcare or management operations it is referring to Universal Health Services' subsidiaries including UHS of Delaware. Further, the terms "we," "us," "our" or "the company" in such context similarly refer to the operations of Universal Health Services' subsidiaries including UHS of Delaware. Any employment referenced in this website is not with Universal Health Services, Inc. but solely with one of its subsidiaries including but not limited to UHS of Delaware, Inc.
