Drg Validation Auditor

Vedi l’offerta su Go Lavoro: golavoro.it/annuncio-lavoro/8ctxay

h3Role and Responsibilities /h3pNon è affidabile/a delle competenze necessarie per questa opportunità? Legga la descrizione completa qui sotto per avere un quadro completo dei requisiti richiesti. /ppThe DRG Validation Auditor is a valued member of the Penstock Audit team, responsible for reviewing inpatient claims and ensuring that the DRG paid is fair and accurate, based on the documentation in the medical record and the application of ICD-10-CM and ICD-10-PCS coding conventions, instructions, guidelines, policies, and Coding Clinic advice. The DRG Validation Auditor upholds the standards of honesty, excellence, and innovation that are central to the Penstock mission. /pulliConducts thorough, thoughtful reviews of healthcare claims and medical records to identify discrepancies between the physician documentation, the clinical picture depicted in the record, the codes billed, and the resulting DRGbr/ /liliAppropriately uses industry-recognized references to support review findings, including the ICD-10-CM and ICD-10-PCS Official Guidelines for Coding and Reporting, AHIMA Standards of Ethical Coding, AHIMA Practice Briefs related to compliant querying, and AHA Coding Clinicsbr/ /liliWrites complete, clear, and accurate rationale to support audit determinations, citing specific information from the record, and referencing appropriate guidelines, policies, regulations, and/or Coding advicebr/ /liliKeeps abreast of coding, clinical, regulatory, and other industry changes that impact Penstock auditing and/or that suggest new audit opportunitiesbr/ /liliMaintains focus on the identification and development of new audit conceptsbr/ /liliContinuously considers the systems and processes involved with healthcare reimbursement (both internal and external) and communicates ideas for improvement through appropriate channelsbr/ /liliParticipates in focused training to learn new auditing skills across a myriad of clinical and coding scenariosbr/ /liliCommunicates kindly, professionally,



and effectively with all customers, both internal and external, and refers issues to management as appropriatebr/ /liliContinuously strives to find new avenues for fulfilling the Penstock mission of reclaiming greater integrity between payors and providersbr/ /liliServes as a Payment Integrity subject matter expert for Penstock team members and for the Goodroot organization as a wholebr/ /liliMeets or exceeds Penstock’s performance and quality standards.br/ /liliSenior Auditor positions provide support for Team Lead as required.br/ /li /ulh3Qualifications and Education Requirements /h3ulliMinimum of an associate degreebr/ /liliCurrent AHIMA Health Information Management credential(s): RHIT or RHIAbr/ /liliCurrent AHIMA/AAPC Coding Credential: CCS or CICbr/ /liliCurrent Clinical Validation credential(s): CDIP, CCDS, or CDEIbr/ /lili3 or more years of ICD-10 inpatient coding experiencebr/ /lili1 or more years of clinical experience in a healthcare facility settingbr/ /lili3 or more years of auditing experience (or demonstrated equivalent)br/ /lili1 or more years of auditing experience in a payor settingbr/ /lili1 or more years of experience in Inpatient Rehabilitation coding/auditingbr/ /lili1 or more years of experience in Inpatient Psychiatric coding/auditingbr/ /liliComprehensive understanding of ICD-10-CM Inpatient Coding Guidelines, AHA Coding Clinic, and DRG grouping mechanicsbr/ /liliStrong current clinical knowledgebasebr/ /liliFamiliarity with Clinical Documentation Integrity practicesbr/ /liliAwareness of and adherence to HIPAA,



and all laws regarding the safeguarding of PHI/PIIbr/ /liliAbility to conduct independent research using credible sourcesbr/ /liliDemonstrated working knowledge of Microsoft Word, Excel, and PowerPointbr/ /liliAbility to apply critical thinking skills to record reviewsbr/ /liliAbility to work independently, manage workload, and adapt to shifting prioritiesbr/ /liliWillingness to adapt and learn new auditing skills across a myriad of coding and clinical scenariosbr/ /liliExcellent communication skills, both oral and writtenbr/ /liliComfortable working in an ever-changing fast paced environmentbr/ /liliAble to work Eastern time zone hoursbr/ /liliSecure and private home office with reliable high-speed internet connectionbr/ /li /ulh3Preferred Skills /h3ulliBachelor’s degreebr/ /liliAHIMA/AAPC/ACDIS Auditing Credential: Auditing: Inpatient Coding Microcredential through AHIMA, Certified Professional Medical Auditor (CPMA) through AAPCbr/ /lili5+ years of inpatient ICD-10 coding and auditing experiencebr/ /lili5+ years of relevant auditing (clinical validation and medical necessity) experiencebr/ /liliAHIMA/AAPC Coding Certifications (RHIA, RHIT, CCS, CPC, CPC-H), AHIMA/ACDIS Clinical Documentation Certification (CDIP, CCDS), or Clinical Documentation Integrity experiencebr/ /lili1-5 years of Inpatient Rehabilitation Coding/Auditingbr/ /lili1-5 years of Inpatient Psychiatric Coding/Auditingbr/ /li /ulpPenstock is an affiliate company of Goodroot, which launches and grows companies dedicated to putting patients back in the center of healthcare. Penstock is an Equal Opportunity Employer. /ph3About Goodroot /h3pGoodroot is a community of companies committed to delivering more access to better healthcare at a lower cost. xlwpduy With a growing group of brands including, but not limited to Penstock, Navion, and Emry, Goodroot is reshaping healthcare for good, one system at a time. Learn more at J-18808-Ljbffr /p #J-18808-Ljbffr

Vedi l’offerta su Go Lavoro: golavoro.it/annuncio-lavoro/8ctxay