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DRG Validator

RevCycle Xperts
Remote

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Job Details

Part-time | Full-time | Contract

Benefits

Flexible schedule

Qualifications

RHIT
Windows
Certified Coding Specialist
Documentation review
DRG

Full Job Description

RevCycle Xperts, Inc. (RCX) is looking for certified, credentialed and experienced ICD-10-CM/DRG Reviewers with 4 to 5 years of experience. Join our leading team in DRG and Clinical validation services. We specialize in revenue cycle integrity auditing on both Provider and Payor sides of healthcare delivery.

Our business model is one of the most progressive in the nation. RCX, a leading provider of DRG and Clinical validation services, offers unique opportunities for you to have the flexibility in scheduling your own hours as long as you meet the minimum 20 hours per week requirement. All work is remote.!!

So, join RevCycle Xperts (RCX) in providing cutting edge revenue cycle integrity auditing serving both Providers and Payors.

If you have RHIA, RHIT, CCS and CDI/ CCDS (with CCS) and 4+ years of auditing experience, please send your resume.

Job Expectations:

· Perform comprehensive inpatient DRG validation reviews to determine accuracy of the DRG billed, based on industry standard ICD 10 coding guidelines and the clinical evidence supplied by the provider in the form of medical records.

· Based on the evidence presented in the medical records, determine, and record the appropriate (revised) Diagnosis Codes, Procedure Codes and Discharge Status Code applicable to the claim.

· Utilize proprietary workflow systems and encoder tools (e.g., 3M, Webstrat, etc.) efficiently and accurately to make audit determinations, generate audit rationales.

· Meet or exceed established project productivity and quality goals by moving claims through workflow process appropriately.

Qualifications and Education Requirements

· Expert inpatient coding skills with superior knowledge of regulatory ICD-10-CM / PCS

coding, Official Guidelines for Coding and Reporting and Coding Clinic Guidance

coupled with MS-DRG and APR-DRG payment methodologies with one or more of the following credentials preferred:

§ CCS or CIC

§ RHIA or RHIT

Thorough understanding of the revenue cycle and the various DRG Groupers necessary for case assignments & payor-specific billing/reimbursement.
3+ years reviewing and/or auditing ICD-10 CM, MS-DRG and APR-DRG claims preferred.
Able to work a minimum of 20 hours per week-flexible hours!!!!

Preferred Skills

Proficiency in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint) and Google applications; prefers knowledge in the use of intranet and internet applications.
Prefer candidate with prior DRG retrospective overpayment identification auditing experience.
Experience working in a remote environment.
Excellent communication skills written and verbal.

Additional Notes

This position is for Payer/Insurance claim reviews.

May include resolution expertise in complex review cases.

Job Types: Full-time, Part-time, Contract

Benefits:

Flexible schedule

Experience:

DRG: 3 years (Required)

Work Location: Remote

Quick Apply

Refine Your Search

medical billing contract jobs

DRG Validator

Insurance Billing Specialist

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Medical Billing Specialist

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Coding Specialist

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Inpatient Coding Associate (Flexible)

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