Clinical Documentation Specialist - DRG Validation

Location: WILTON, CT, USA

Salary: $39.00 USD Hourly - $41.00 USD Hourly

Description: Job Title: Clinical Documentation Specialist - DRG Validation Auditor

Type: Temp to Hire

Location: Fully Remote

Pay: Dependent on Experience

Training Hours: Eastern Time, between 8 AM – 4 PM (Monday - Friday)

Work Hours: 8 hours straight between 6 AM and 6 PM EST (Monday - Friday)

Job Responsibilities

• Analyze and Audit Claims: Utilize advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to review medical records and episodes of care. Perform work independently with objectivity.
• Utilize Audit Tools: Proficiently use proprietary auditing systems to make audit determinations and generate audit letters.
• Meet Productivity Standards: Maintain production goals set by the audit operations management team.
• Ensure Accuracy and Quality: Achieve the expected level of accuracy and quality in valid claim identification and documentation (letter writing).
• Identify New Claim Types: Discover potential claims outside of the current concept for additional recoveries. Suggest and develop high-quality, high-value concepts and process improvements.
• Complete Annual Performance Plan: Fulfill all responsibilities outlined on the annual Performance Plan.
• Handle Special Projects: Complete all special projects and other duties as assigned.
• Ensure Accommodation Compliance: Perform duties with or without reasonable accommodation.
  
  

Qualifications & Requirements

• Education: (One of the following is required)
• Associate or Bachelor's degree in Nursing (active/unrestricted license)
• Associate or Bachelor's degree in Health Information Management (RHIA or RHIT)
• Coding/CDI Certification: (One of the following is required and must be maintained as a condition of employment)
• RHIA or RHIT
• CPC or COC
• Inpatient Coding Credential (CCS, CIC, CDIP, or CCDS)
  
  

Experience: (Required)

• 5 to 7 years of experience with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG, along with 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, CMS, and other regulatory compliance guidelines and mandates. Requires expert coding knowledge - DRG, APR-DRG, ICD-10, CPT, HCPCS codes.
• Working knowledge of applicable industry-based standards.
• Proficiency in Word, Access, Excel, TEAMS, and other applications.
• Excellent written and verbal communication skills.
  
  

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Contact: mgautreau@judge.com

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