Responsible for reviewing medical records to validate coding and DRG assignment accuracy, ensuring physician documentation supports hospital coded data.
The role uses expertise in acute facility-based clinical documentation, inpatient coding, MS-DRG, APR-DRG, and ICD-10 to audit claims and support payment integrity.
Requirements & Qualifications
All Levels
- Associate or bachelor's degree in Health Information Management (RHIA or RHIT) or a nursing degree.
- 3+ years of experience in claims auditing, quality assurance, or recovery auditing for MS/APR DRG coding in a hospital or acute facility setting.
- 3+ years of experience with ICD-10-CM, MS-DRG, and APR-DRG, plus knowledge of medical claims billing/payment systems, provider billing guidelines, medical necessity criteria, and coding terminology.
- Maintain RHIA, RHIT, CCS, or CIC certification as a condition of employment.
- Intermediate analytical, problem-solving, PC, software, auditing tools, and claims processing system skills.
Level II
- 5+ years of relevant DRG auditing experience.
- Advanced analytical, problem-solving, and judgment skills.
- Demonstrated ability to lead initiatives and work across multiple skills, products, processes, and systems.
Level III
- 8+ years of relevant DRG auditing experience.
- Demonstrated leadership skills and ability to serve as a subject matter expert or consultant.
- Expert proficiency in analytical skills, auditing, project management, and presentation skills.
Benefits & Perks
May include:
- Group health insurance
- Dental insurance
- Retirement plan
- Wellness program
- Paid time away from work
- Paid holidays
Location
Buffalo, New York, US
Employment Type
Full-time
Experience Level
Intermediate Level
Salary Range
$65,346 - $142,322
Remote work allowed
Yes
Posted
3 months ago