Job Details

Hi There,

We have a job opening with one of our clients. Please find the below details and let me know if you are interested to discuss further.

Role: Medical coding Auditor (DRG)

Location: Remote/Travel/ San Antonio TX, Nashville TN

Type: Full-time

Our Client is hiring a DRG Auditor III. This Hybrid role requires auditing in specific provider location in San Antonio, TX and Nashville, TN. To be onsite at the provider location will require some travel once per quarter. The amount of travel outside the metropolitan area will vary based on your location / proximity to client facilities and Client need

• Residents in or near the greater San Antonio, TX area: Client in San Antonio, TX with 10-20% travel estimated outside of San Antonio
• Residents in or near the greater Nashville, TN area: Client in Nashville, TN with 10-20% travel estimated outside of Nashville
• Residents outside of these two areas will possibly average 35-40% travel in going to these client locations quarterly.
• Future travel may include Tampa, FL and Richmond, VA.
• Hybrid: Remote auditing when not onsite auditing.

Note that travel expenses will be reimbursed.

The responsibilities of the DRG Coding Auditor is to perform DRG reviews by validating accuracy of the DRG or APR DRG code assignment completeness, POA, discharge status, etc to ensure accurate payment by our clients. The coding auditor determines if a discrepancy exists in the coding and documents the findings using standard documentation guidelines applicable to the program. The audits can be done as desk or as onsite in which case the coding auditor might have to travel to the providers location on an agreed upon schedule and perform the audit review.

Essential Duties and Responsibilities

Reviews medical records and coding to validate clinical coding

Ability to write professional finding notes based on client's policies using official coding guidelines, ICD-10 coding handbook, coding clinic or other recognized sources

Enters all required DRG review information into encoder program to obtain validated DRG

Identifies questionable encoder results and reviews with program manager

Takes responsibility for updating status of audit in the audit workflow system

Schedules and performs onsite audits in accordance with the program policies and procedures

Works independently-

Needs to meet established program productivity and quality goals

Escalates facility issues to manager for resolution

Review appeal information and render coding decision to either uphold or overturn original finding

Participate in Inter Rater Reliability quality reviews

Comply with all Client Employee Handbook policies and procedures

Comply with HIPAA and other regulations regarding confidentiality of information

Adhere to established client Policies and Procedures

Perform other duties as assigned.

Education Requirements

Minimum High School Diploma CCS, CIC, CPC with Inpatient Experience

Work Experience Requirements

Required: 1 year inpatient hospital coding or auditing experience