Remote MSDRG Auditor

About the role

The DRG Validation Auditor is a member of the CGI Healthcare Compliance, DRG Validation Team, with responsibility for reviewing medical records to determine the accuracy of coding and reimbursement for clinical services rendered to beneficiaries of health plans, including Commercial and Government Clients.

Responsibilities

• Reviews inpatient medical records to validate assignment and sequencing of ICD-10 diagnosis and procedure codes, discharge status codes, Hospital Acquired Conditions (HACs), POA assignment, and DRG assignment.
• Provides a detailed rationale for every medical record review resulting in a DRG Review Results letter, including supporting references.
• Follows proper procedure for referral to Clinical Nurse Auditor or Physician Advisor, as applicable.
• Utilizes proper reference material, standards, and guidelines for coding.
• Provides input to the Edit Development team on claims selection criteria.
• Verifies data received from client and work to resolve discrepancies.
• If the contract requires onsite review, interacts with Providers and other personnel in a professional manner.
• Follows CGI policies and processes, completing Red Carpet, timesheets, payroll, travel expense documents, and other corporate requirements in a timely manner.
• Communicates timely with Team Lead regarding illnesses, appointments, vacation requests, changes in work schedule, performance barriers, and computer issues.
• Complies with department standards regarding productivity and audit quality.
• Performs other duties as assigned.

Requirements

• Credentials: The DRG Validation Auditor possesses current AHIMA credentials (RHIT/RHIA/CCS), with current CCS preferred.
• Experience: The Auditor demonstrates extensive knowledge of ICD-10-CM/PCS coding and DRG reimbursement, with a minimum of five (5) years of inpatient coding experience. Previous experience training and mentoring junior-level coders is highly desired.
• Methodology: The DRG Validation Auditor must understand government and commercial provider reimbursement methodologies (MS-DRG and APR-DRG), and possesses strong clinical validation skills, as well as data analytic skills.
• Technical Skills: A working knowledge of computer functions and applications such as Microsoft Office (Outlook, Word, Excel) and Windows operating systems is required in order to manage applications utilized in the audit process.
• Communication: The ability to write a well-reasoned review in a narrative style, with accurate spelling, grammar, punctuation, and sentence structure is required for success in the audit position.
• Core Competencies: The auditor must be able to adapt to changing priorities in order to meet Client requirements, and is required to meet department productivity standards and deadlines.
• Attributes: The auditor must be proactive and self-directed, self-sufficient in completing tasks, as well as detail-oriented, with a passion for life-long learning.

Qualifications

• To Be Successful In This Role: Credentials - The DRG Validation Auditor possesses current AHIMA credentials (RHIT/RHIA/CCS), with current CCS preferred. Experience - The Auditor demonstrates extensive knowledge of ICD-10-CM/PCS coding and DRG reimbursement, with a minimum of five (5) years of inpatient coding experience. Previous experience training and mentoring junior-level coders is highly desired. Methodology - The DRG Validation Auditor must understand government and commercial provider reimbursement methodologies (MS-DRG and APR-DRG), and possesses strong clinical validation skills, as well as data analytic skills. Technical Skills - A working knowledge of computer functions and applications such as Microsoft Office (Outlook, Word, Excel) and Windows operating systems is required in order to manage applications utilized in the audit process. Communication - The ability to write a well-reasoned review in a narrative style, with accurate spelling, grammar, punctuation, and sentence structure is required for success in the audit position. Core Competencies - The auditor must be able to adapt to changing priorities in order to meet Client requirements, and is required to meet department productivity standards and deadlines. Attributes - The auditor must be proactive and self-directed, self-sufficient in completing tasks, as well as detail-oriented, with a passion for life-long learning.

Skills

• ICD-10-CM/PCS Coding
• DRG Reimbursement
• Government and Commercial Provider Reimbursement Methodologies (MS-DRG and APR-DRG)
• Strong Clinical Validation Skills
• Data Analytic Skills
• Microsoft Office (Outlook, Word, Excel)
• Windows Operating Systems
• Narrative Writing

Benefits

• Competitive compensation
• Comprehensive insurance options
• Matching contributions through the 401(k) plan and the share purchase plan
• Paid time off for vacation, holidays, and sick time
• Paid parental leave
• Learning opportunities and tuition assistance
• Wellness and Well-being programs

Pay

A reasonable estimate of the current range for this role in the U.S. is $58,000.00 - $114,900.00.

Schedule

Candidates must be willing to work in Eastern Time Zone hours.