Certified Clinical RN Chart Reviewer

Job Summary

To support a culture of continuous improvement, the full-time Certified Clinical RN Chart Reviewer will perform clinical reviews of medical records to validate claims coding accuracy, medical necessity, and appropriateness of treatment settings, working remotely.

Key responsibilities

• Audit and analyze neonatal intensive care unit (NICU) claims according to ICD-10 coding principles and clinical guidelines
• Ensure claims analysis complies with ethical coding standards, guidelines, and regulatory requirements
• Research reimbursement regulations for claim payment compliance to support and validate audit findings

Required qualifications

• Registered Nurse required, preferably with NICU experience
• 2+ years of experience with inpatient claims, preferably NICU and maternity
• Inpatient Coding Certification (CCS or CIC) required, or must obtain within 6 months of hire
• Solid understanding of MS-DRG, AP-DRG, and APR-DRG payment systems
• Expert knowledge of DRG, ICD-10, CPT, and HCPCS codes