Clinical Validation Auditor - RN, CDI, MS-DRG, AP-DRG, APR-DRG

Responsibilities Auditing inpatient medical records to ensure clinical documentation supports the conditions and DRGs billed and reimbursed Analyzing and auditing claims by integrating medical chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities Drawing on advanced ICD-10 coding expertise, mastery of clinical guidelines, and industry knowledge to substantiate conclusions Utilizing audit tools, auditing workflow systems and reference information to generate audit determinations and formulate detailed audit findings letters Maintaining accuracy and quality standards as established by audit management Identifying potential documentation and coding errors by recognizing aberrant coding and documentation patterns such as inappropriate billing for readmissions, inpatient admission status, and Hospital-Acquired Conditions (HACs) Suggesting and developing high quality, high value, concept and or process improvement and efficiency recommendations Requirements Requires current, active, unrestricted Registered Nurse license in applicable state(s) Requires a minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation improvement Requires a minimum of 5 years of experience working with ICD-9/10CM,

MS-DRG

, AP-DRG and APR-DRG One or more of the following certifications are preferred: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Clinical Documentation Specialist (CCDS), Certified Documentation Improvement Practitioner (CDIP), Certified Professional Coder (CPC) or Inpatient Coding Credential such as CCS or CIC Experience with third party DRG Coding and/or Clinical Validation Audits or hospital clinical documentation improvement experience preferred Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing guidelines, payer reimbursement policies, and coding terminology preferred. Hard Skills ICD-10 coding ICD-9 coding MS-DRG

AP-DRG

APR-DRG

claims auditing clinical documentation improvement medical chart coding audit tools quality assurance Soft Skills attention to detail analytical skills communication skills problem-solving organizational skills process improvement objectivity critical thinking recommendation development team collaboration Certifications & Qualifications Registered Nurse (RN) Registered Health Information Technician (RHIT) Registered Health Information Administrator (RHIA) Certified Clinical Documentation Specialist (CCDS) Certified Documentation Improvement Practitioner (CDIP) Certified Professional Coder (CPC) Certified Coding Specialist (CCS) Certified Inpatient Coder (CIC) #J-18808-Ljbffr Jobtailor