Internal Audit Specialist
L3Harris Technologies
DRG 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 cases denied by payors.
- Formulates and submits letters of appeal utilizing relevant clinical documentation from the medical record.
- Performs reviews of accounts denied for DRG validation and DRG downgrades.
- Documents in appropriate denial tracking tool (ACE) and maintains reports for leadership.
- Identifies payment methodology of accounts, including Managed Care contract rates and Medicare rates.
- Collaborates with Physician Advisors and CRC leadership for documentation-specific areas of concern.
- Maintains expertise in clinical areas and current trends in healthcare, inpatient coding, and reimbursement methodologies.
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
- Must have expertise with Interqual and/or MCG Disease Management Ideologies
- Strong understanding of rules and guidelines, including AHA’s Coding Clinics, American Association of Medical Audit Specialists (AAMAS), National Commission on Insurance Guidelines and Medicare Billing Guidelines (CMS), State Funded Billing Regulations (Arizona, California, Nevada) and grievance process; working knowledge of billing codes such as RBRVS, CPT, ICD-10, HCPCS.
Benefits
- Medical, dental, vision, disability, life, and business travel insurance
- Paid time off (vacation & sick leave) – min of 12 days per year, accrued 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.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
clinical documentationinpatient codingdischarge planningutilization managementcase managementperformance improvementmanaged care reimbursementInterqualMCG Disease Management Ideologiesbilling codes
Certifications
RN LicenseBSN Degree
