Clinical RN Auditor

Job Summary

Utilizing expert knowledge of MS-DRG and APR-DRG coding methodologies, the remote Clinical RN Auditor will conduct inpatient claim audits to validate ICD-10 codes and identify overpayments while managing daily case reviews in a high-volume environment.

Key responsibilities

• Conduct MS-DRG and APR-DRG coding reviews to verify accuracy of DRG assignments and reimbursement
• Utilize knowledge of ICD-10 coding guidelines to ensure proper code assignment and compliance with CMS requirements
• Write clear rationales supporting audit findings based on coding guidelines and clinical documentation

Required qualifications

• Associate's degree
• Unrestricted RN (Registered Nurse) license
• CCS/CIC certification or willingness to obtain within 6 months of hire
• 2+ years of MS DRG/APR DRG coding experience in a hospital environment
• 2+ years of ICD-10-CM and ICD-10-PCS coding experience with expert knowledge of coding guidelines