The DRG Clinical Auditor is responsible for performing DRG validation reviews of medical records and other documentation. The role determines correct DRG and coding based on review methodologies, completes medical record reviews, documents findings and non-findings accurately, and provides clinical, policy, and regulatory support for determinations.
The position requires strong knowledge of ICD-10-CM and ICD-10-PCS coding guidelines, modern pharmacology, disease management, clinical intervention procedures, and medical necessity rules. The auditor works closely with quality control and medical leadership to support accurate reimbursement and identify potential savings.
Knowledge and Skills
- Proficient understanding of Medicare, CMS guidelines, and ICD-10 coding guidelines
- Effective verbal and written communication skills
- Ability to work independently and in a team environment
- High attention to detail
- Strong critical thinking skills
- Ability to multitask and support team coverage when needed
- Ability to build relationships internally and externally
- Ability to work in a fast-paced environment
- Basic computer skills and typing proficiency
- Proficiency with Microsoft Office
Education and Experience
- LVN or RN license in the state of employment preferred
- CCS or CIC required with DRG auditing experience in ICD-10-CM and ICD-10-PCS
- Experience in the OR, ICU, or ER as an RN highly preferred
Benefits
- Medical (HDHP) with pharmacy
- Dental
- Vision
- Long-term disability
- Health Savings Account (HSA)
- Flexible Spending Account options
- Life insurance
- Accident insurance
- Critical illness insurance
- Pre-paid legal insurance
- Parking and transit FSA accounts
- 401(k) and Roth 401(k)
- Paid time off
Location
Fort Worth, Texas, US
Employment Type
Full-time
Experience Level
Intermediate Level
Salary Range
$70,143 - $107,253
Remote work allowed
No
Posted
4 months ago