Job Summary
A company is looking for a Payment Integrity Professional/Operations Manager for DRG, Outpatient & Surgical Specialty coding.
Key Responsibilities:
- Review provider disputes, appeals, and create coding rules for selections
- Ensure accuracy of provider contract payments and correct claims payment
- Review medical documentation for clinical indicators and perform CPT procedure review
Required Qualifications:
- CCS or CPC Certification
- MS-DRG and APR-DRG auditing experience
- Minimum 5 years' work experience in outpatient Specialty Surgeries and Procedures
- Minimum 5 years' experience in performing inpatient(DRG) coding audits
- Bachelor's degree or higher in Health Information Management or related field preferred