Note: The job is a remote job and is open to candidates in USA. CorVel Corporation is a certified Great Place to Work® Company, dedicated to accuracy and transparency in healthcare payments. The Diagnostic Related Groups (DRG) Clinical Auditor will perform DRG validation reviews of medical records, ensuring accurate coding and compliance with internal and external policies.
Responsibilities
- The Clinical Auditor will review medical records to determine accuracy of billing through verification of coding and review of supporting clinical documentation
- Conduct audits to ensure accurate reimbursement and identifying potential savings
- Demonstrated knowledge of ICD-10-CM codes, PCS and DRG coding, understanding of payer rules and regulations, including Medicare and Medicaid
- Understand and comply with all internal and external policies
- Working knowledge of HIPAA Privacy and Security Rules
- Assist Quality Control team and medical director with appeals, rebuttals, etc
- Notify leadership of any issues or concerns in a timely manner
- Additional duties as assigned
Skills
- LVN or RN license in the state of employment preferred
- CCS or CIC required with DRG auditing experience in ICD-10-CM, ICD-10 PCS
- Demonstrated knowledge of ICD-10-CM codes, PCS and DRG coding, understanding of payer rules and regulations, including Medicare and Medicaid
- Proficient understanding of Medicare, CMS guidelines and ICD-10 coding guidelines
- Effective and professional communication skills, both verbal and written
- Ability to work independently and in a team environment
- High attention to detail
- Must possess critical thinking skills
- Ability to multi-task and assist with team coverage and provide support when needed
- Ability to build relationships both internally and externally
- Ability to work in a fast-paced environment
- Demonstrated proficiency in basic computer skills and typing
- Proficiency with Microsoft Office
- Experience in the OR, ICU, or ER as an RN highly preferred
Benefits
- Medical (HDHP) w/Pharmacy
- Dental
- Vision
- Long Term Disability
- Health Savings Account
- Flexible Spending Account Options
- Life Insurance
- Accident Insurance
- Critical Illness Insurance
- Pre-paid Legal Insurance
- Parking and Transit FSA accounts
- 401K
- ROTH 401K
- Paid time off
Company Overview
CorVel is a nationally recognized claims management and managed care provider with over 30 years of experience in the industry. It was founded in 1987, and is headquartered in Irvine, California, USA, with a workforce of 1001-5000 employees. Its website is https://www.corvel.com/.