Search for Jobs

12 Results
Versalus Health
Work from home, NA, United States
1 day ago
EXL
Remote, NA, United States
3 days ago
AMN Healthcare Revenue Cycle Solutions
NA, United States
6 days ago
CorroHealth
Remote, NA, United States
6 days ago
Nuvance Health
Danbury, CT, United States
9 days ago
Cloudmed
Remote, AZ, United States
11 days ago
Franciscan Alliance
Remote, NA, United States
24 days ago
UCLA Health
Los Angeles, CA, United States
27 days ago
Conifer Health Solutions
Frisco, TX, United States
30+ days ago
HCCS (Healthcare Coding & Consulting Services)
Anywhere, United States
30+ days ago
UASI
Remote, NA, United States
30+ days ago
Duke University Health System
Durham, NC, United States
30+ days ago
1 - 12 Results of 12
Versalus Health
Work From Home, United States
1 day ago

Description

DRG Validation Auditor, Full Time

Office Location: Remote opportunities (within the United States) 

Commitment: Full-Time

About Versalus Health

Versalus Health is an innovative, rapidly growing organization that provides hospitals with comprehensive solutions focused on the intersection of utilization management, revenue cycle, and compliance. Versalus Health has expanded its product offering to include DRG Revenue Integrity services. Versalus Health provides programmatic solutions for DRG compliance and revenue integrity by leveraging advanced analytics and DRG auditing and clinical expertise. Versalus offers outstanding growth opportunities, a competitive salary and benefits package including bonuses based on individual and company performance, and reimbursement for continuing education and association dues. Versalus has a vibrant culture that strives to promote a positive work/life balance. Join our team and positively change healthcare!

Job Description:

 The DRG Validation Auditor utilizes data analytics and proprietary algorithms to perform prebill or post bill DRG and Clinical Validation reviews to identify revenue integrity issues and opportunities. This position requires expert knowledge of MS-DRG and APR-DRG payment methodologies. The Auditor is responsible for validating ICD-10-CM/PCS codes by examining medical record documentation of clinical findings, care rendered, and the assignment of present on admission (POA) indicators and discharge disposition status for claims under review.

Job Responsibilities: 

  • Identifies both over and under payments. Reviews medical records and other hospital documents to validate that the clinical documentation supports the assigned ICD-10-CM/PCS codes, the selection of the principal diagnosis and discharge disposition following CMS requirements, Official Guidelines for Coding and Reporting, and Coding Clinic guidance.
  • Effectively Utilizes Audit Tools. Utilizes 3M encoder and grouper software with advanced proficiency. Enters audit findings into our proprietary application accurately and in accordance with standard procedures.
  • Meets or exceeds standards for both quality and productivity set by the organization.
  • Other responsibilities as assigned. Duties may be subject to change at any time at the discretion of management, formally or informally, verbally or in writing.


Requirements

Required Education/Certification/Experience:

  • RN/RHIA/RHIT with CDIP or CCDS required. CCS is highly preferred and will be required after one year of employment. (Assistance is available for preparation.)
  • CDI/coding certifications, and/or professional license must be maintained as a condition of employment.
  •  A minimum 5 years of hospital or vendor inpatient coding and/or CDI experience required.
  • DRG appeal experience highly preferred.

Knowledge, Skills, and Abilities: 

  • Expert Inpatient Coding Skills. Possess regulatory ICD-10-CM/PCS coding expertise coupled with subject matter expertise in MS-DRG and APR-DRG payment methodologies including Hospital Acquired Conditions (HACs), POA assignment, and Discharge Disposition codes.
  • Clinical Validation Skills. Ability to apply current industry standard clinical indicators, risk factors and treatment protocols used in clinical validation of payment impacting code assignment. Solid command of anatomy, physiology, pathology, laboratory, imaging, pharmacology, and disease assessment, management, and treatment.
  • Critical Thinking. Actively and skillfully conceptualizes, applies, analyzes, synthesizes, and evaluates information gathered from, or generated by observation, experience, reflection, reasoning, or communication as a guide to validate audit results and correct as necessary.
  • Adaptability. Maintains effectiveness when experiencing changes in work tasks or the work environment; adapts to change in environment and/or circumstances with a positive outlook and adjusts effectively to work within new work structures, processes, requirements, or cultures.
  • Initiative. Proactive and self-directed. Shows initiative and responsibility in taking the necessary steps towards problem resolution. Is self-sufficient and does not need to rely on others to complete a job.
  • Vivacity. Consistently maintains high levels of activity or productivity sustained over long working hours when necessary; operates with vigor, effectiveness, and determination.
  • Performance. Meets or exceeds both production and quality expectations while performing complex medical record audits. Able to execute under pressure of time constraints and while managing multiple responsibilities.
  • Planning and Organization. Proactively prioritizes initiatives, effectively manages resources and can multi-task. Actively manages their work assignments and seeks additional tasks when appropriate.
  • Communication Skills. Communicates clearly, proactively, and concisely with all key stakeholders. Excellent written and verbal communication skills. Writes clear, compelling, accurate, and concise justifications in support of findings and successfully crafts appeal letters with precise logic.
  • Curious. Actively seek out new ideas, possibilities, and answers to the tough questions. Committed to life-long learning.
  • Detailed Oriented. Pays meticulous attention to detail, identifies aberrant code assignment, mines medical records for all relevant and supporting evidence, and conscientiously follows all steps in the audit.
  • PC Skills. Demonstrates proficiency in Microsoft Office, and Teams, Skype, WebEx, VPN access, navigating a variety of EHRs, and ability to problem solve Internet connectivity issues.

Benefits

  • Enjoy work-life balance with a predictable schedule
  • Compensation includes salary plus bonus opportunities
  • Medical, Dental, Vision coverage, 401K
  • Holidays, paid time off, short term and long-term disability insurance, and life insurance
  • Reimbursement for continuing education and association dues

Physical Requirements:

May be expected to sit at a desk for long hours. Must have a private and secure space to work, including a secure Internet connection. Repetitive movement of hands and fingers – typing and/or writing. Occasional standing, walking, stooping, kneeling or crouching. Ability to reach with hands and arms, talk, and hear. Exert up to 20 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects.

Versalus Health is an Equal Opportunity Employer and considers applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics, or any other basis forbidden under federal, state, or local law.

Job Information

  • Job ID: 56262162
  • Location:
    Work From Home, United States
    Remote, United States
    Glen Allen, Virginia, United States
  • Position Title: DRG Validation Auditor, Full Time
  • Company Name: Versalus Health
  • Industry: Consultant/Vendor
  • Job Function: Academic Administrator,
    Auditing
  • Job Type: Full-Time
  • Min Education: Associate
  • Min Experience: 5-7
  • Required Travel: None
  • Salary: $85,000.00 - $95,000.00 (Yearly Salary)

By leveraging advanced analytics and DRG auditing and clinical expertise, Versalus Health provides programmatic solutions for DRG compliance and revenue integrity.

View Full Profile

Jobs You May Like
Filters
Job Function
State
Country