Certified Clinical RN Chart Reviewer

To support a culture of continuous improvement, the full-time Certified Clinical RN Chart Reviewer will perform clinical reviews of medical records to validate claims coding accuracy, medical necessity, and appropriateness of treatment settings, working remotely. Key responsibilities Audit and analyze neonatal intensive care unit (NICU) claims according to ICD-10 coding principles and clinical guidelines Ensure claims analysis complies with ethical coding standards, guidelines, and regulatory requirements Research reimbursement regulations for claim payment compliance to support and validate audit findings Required qualifications Registered Nurse required, preferably with NICU experience 2+ years of experience with inpatient claims, preferably NICU and maternity Inpatient Coding Certification (CCS or CIC) required, or must obtain within 6 months of hire Solid understanding of MS-DRG, AP-DRG, and APR-DRG payment systems Expert knowledge of DRG, ICD-10, CPT, and HCPCS codes