Nurse Coder DRG Auditor III

📋 Description

• Independently perform DRG and APC validation using applicable coding and clinical guidelines.
• Review medical records to validate principal and secondary diagnoses, diagnosis sequencing
• Evaluate short-stay claims to determine whether the documentation supports the medical necessity of
• Apply CPT, ICD-10, CMS, commercial payer, InterQual, MCG, and applicable organizational policies
• Conduct independent audits of inpatient and outpatient claims and communicate findings clearly.
• Prepare responses to claim appeals using industry standards and applicable client and

🎯 Requirements

• Active RN professional license in good standing.
• Relevant clinical practice experience.
• Current coding certification in good standing, such as CCS or CIC.
• Demonstrated experience in coding validation, claims auditing, or payment integrity.
• Strong understanding of CPT and ICD-10 coding guidelines and clinical documentation.
• Ability to interpret medical records and apply coding, clinical, regulatory, and payer-specific

🎁 Benefits

• Competitive salary and comprehensive compensation package.
• Health insurance and other valued healthcare benefits.
• 401(k) retirement plan with employer matching.
• Paid parental leave.
• Collaborative and innovative work environment.
• Opportunity to operate as a subject matter expert and influence coding and auditing practices.