Job Summary
A company is looking for a Payment Integrity Professional/Operations Manager for DRG, Outpatient & Surgical Specialty coding - Remote/Virtual in US.
Key Responsibilities:
- Review provider disputes, appeals, and create coding rules for selections in a metrics-driven environment
- Contribute to cost reduction by ensuring accurate provider contract payments and correct claims payment
- Review medical documentation for clinical indicators, perform CPT procedure review, and analyze database
Required Qualifications:
- CCS or CPC Certification
- Experience with MS-DRG and APR-DRG auditing
- Minimum 5 years' 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 (HIM) or related field
