Employer Industry: Healthcare Payment Solutions

Why Consider this Job Opportunity:

- Competitive pay up to $100,056 annually
- Opportunity for career advancement and growth within the organization
- Comprehensive benefits package including medical, dental, vision, and life insurance
- Ability to work independently with minimal supervision
- Chance to work for a certified Great Place to Work® Company
- Supportive and collaborative work environment

What to Expect (Job Responsibilities):

- Perform DRG validation (clinical/coding) reviews of medical records and other documentation
- Review individual medical records for missing documentation and physician's notes supporting assigned DRGs
- Verify accuracy of billing through coding and clinical documentation verification
- Conduct audits to ensure accurate charge capture and identify potential savings
- Communicate findings accurately and clearly

What is Required (Qualifications):

- Minimum of 1 year of recent DRG auditing experience in a hospital setting or health plan
- National Coding Certification required through AHIMA or AAPC
- Extensive hands-on ICD-10 CM / PCS experience
- Working knowledge of current Official Coding Guidelines and Coding Clinic citations
- Proficient in Medicare and CMS guidelines
- Exceptional attention to detail and problem-solving skills
- Effective and professional communication skills, both verbal and written
- Ability to work independently and in a fast-paced environment
- Proficient in Microsoft Office Suite

How to Stand Out (Preferred Qualifications):

- Experience with APR DRG methodology
- Knowledge of payer rules and regulations, including Medicare and Medicaid
- Familiarity with clinical criteria documentation requirements
- Previous experience in a healthcare-related service role
- Strong typing skills

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