Nurse Coder DRG Auditor I (US Remote)

TREND Health Partners is a tech-enabled payment integrity company. Our mission is to facilitate collaboration between payers and providers for mutual benefit and waste reduction, ultimately improving access to healthcare. We achieve this by aligning the common goals of payers and providers and fostering collaboration through a shared technology platform and seamless workflows.Joining TREND Health Partners means becoming part of a dynamic, growing organization that promotes a collaborative and innovative work environment. Our comprehensive compensation package includes competitive salaries, highly valued health insurance, a 401(k) plan with employer match, paid parental leave, and more.The Nurse Coder DRG Auditor's primary responsibility is to review medical records and associated claim information to validate accuracy of DRG assignments and/or medical necessity for inpatient level of care. This role will apply coding and clinical principles based on industry standards and company/client guidelines.Role and Responsibilities Utilize coding guidelines and clinical guidelines to perform DRG validationValidate principal diagnosis, secondary diagnoses, sequencing of diagnoses, discharge statuses and procedures utilizing the medical recordEvaluate short stay claims for medical necessity of an inpatient level of careApply CPT and ICD-10 guidelinesApply policies, procedures, guidelines and regulations developed by Centers for Medicare and Medicaid Services (CMS), commercial payers, InterQual, MCG, and Trend Health PartnersProvide appeal responses for claims of the above types utilizing industry standards and company/client policiesAssist with new concept developmentAssist with claim selection criteriaAssist with itemized bill review as neededMaintain licensures, certifications and continuing education requirementsMay require client communication to support findingsQualifications An active RN professional license in good standingClinical practice experienceCoding certification in good standing. Examples: CCS, CPC, CICCoding validation/auditing experienceWell-developed verbal and written communication skills coupled with recognizable organizationAbility to effectively prioritize tasksMicrosoft Office experience, specifically ExcelPreferred Skills Appeals experience a plusAPR-DRG experience a plusClient communication experience a plusConcept development experience a plusClaim selection experience a plusExperience with machine learning/artificial intelligence a plusCase Management and/or Utilization Review experience a plusClinical Documentation Improvement experience a plusItemized bill validation experience a plusQuality Assurance experience a plusManagement experience a plusRegistered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) a plusTruCode/TruBridge, 3M, WebStrat or similar experience a plusMental and Physical Demands This position will be exposed mainly to an indoor office environment and will be expected to work in or around computers and printers.The nature of the work is sedentary, and the employee will be sitting most of the time.Essential physical functions of the job include typing and the repetitive motion to utilize computer software and hardware continuously throughout the day.Essential mental functions of this position include concentrating on analytical tasks, reading information, and verbal/written communication to others continuously throughout the day.Related duties as assigned This job description documents the general nature and level of work but is not intended to be a comprehensive list of activities, duties, or responsibilities required for this position.Consequently, employees may be asked to perform other duties as required.Employees may also be asked to complete certain compliance requirements set forth by our Business Partners in the performance of their jobs including but not limited to requests for background and drug screenings and disclosures of personal health information or personally identifiable information. Exemptions as provided under the ADA and TITLE VII of the Civil Rights Act will be observed and followed.Reasonable accommodations may be made to enable individuals with disabilities to perform the functions outlined above.Salary: $85,000 - $90,000 a year#J-18808-Ljbffr