Staff IT Auditor
SoFi
Cloud
Registered Nurse – CRC Coding Auditor
Tenet Healthcare
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteSalary
💰 $56,784 - $85,176 per year
Job Level
Mid-LevelSenior
About the role
- Conduct coding and documentation quality reviews and generate responses for claims denied by commercial and government payors
- Formulate and submit letters of appeal using relevant clinical documentation and coding guidelines
- Perform reviews of accounts denied for DRG validation and DRG downgrades
- Document findings in denial tracking tool (ACE) and maintain/distribute reports
- Analyze clinical documentation, evidence-based criteria application, physician documentation, and complete medical record review related to clinical denials
- Identify payment methodology including Managed Care rates, Medicare/State Funded rates, Per-Diems, DRGs, Outliers, and Stop Loss calculations
- Collaborate with Physician Advisors, CRC leadership, Conifer Quality & Performance, and Compliance; escalate trends as warranted
- Assure appropriate actions are taken within appeal time frames
- Maintain expertise in clinical areas, inpatient coding and reimbursement methodologies, and utilization management
- Work collaboratively to review, evaluate and improve the denial appeal process
Requirements
- Completion of BSN Degree Program or three years of experience and completion of BSN within five years of employment
- RN License in the State of Practice
- Current working knowledge of clinical documentation and inpatient coding, discharge planning, utilization management, case management, performance improvement and managed care reimbursement.
- Three to Five years Clinical RN Experience
- Three to Five years of Clinical Documentation Integrity experience
- Expertise with Interqual and/or MCG Disease Management Ideologies
- Strong communication (verbal/written) and interpersonal skills
- Knowledge of CMS regulations
- Knowledge of inpatient coding guidelines
- 1-2 years of current experience with reimbursement methodologies
- CCDS or other related clinical documentation specialist certification, and/or AHIMA or AAPC Coding Credential CCS, CCA, CIC, CPC or CPMA
- Preferred: BSN
- Moderate skills in MS Excel and PowerPoint, MS Office
- Ability to research difficult coding and documentation issues and follow through to resolution
- Ability to work in a virtual setting under minimal supervision
- Ability to conduct research regarding state/federal guidelines and applicable regulatory guidelines related to government audit processes
- Ability to lift 15-30lbs
- Ability to travel approximately 10% of the time
- Candidates may be required to obtain and provide confirmation of required vaccinations and screenings (e.g., COVID-19, influenza) prior to start of employment.
Benefits
- Pay: $56,784.00 - $85,176.00 annually. Compensation depends on location, qualifications, and experience.
- Management level positions may be eligible for sign-on and relocation bonuses.
- Medical, dental, vision, disability, life, and business travel insurance
- Paid time off (vacation & sick leave) – min of 12 days per year, accrued accrue at a rate of approximately 1.84 hours per 40 hours worked.
- 401k with up to 6% employer match
- 10 paid holidays per year
- Health savings accounts, healthcare & dependent flexible spending accounts
- Employee Assistance program, Employee discount program
- Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.
- For Colorado employees, Conifer offers paid leave in accordance with Colorado’s Healthy Families and Workplaces Act.
- Remote work (telecommuting) and virtual work environment
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
clinical documentationinpatient codingutilization managementcase managementperformance improvementmanaged care reimbursementreimbursement methodologiesInterqualMCG Disease Managementdenial tracking
Soft skills
communicationinterpersonal skillscollaborationanalytical skillsproblem-solvingattention to detailresearch skillsability to work independentlyability to follow throughability to meet deadlines
Certifications
RN LicenseCCDSAHIMA Coding CredentialAAPC Coding CredentialCCSCCACICCPCCPMA
