Company Overview
Pride Health is a leading minority-owned healthcare recruitment & staffing firm that offers highly customized business process solutions at cost-effective prices. Headquartered in New York City as a top minority supplier, PRIDE Health offers a broad geographic reach with offices throughout the U.S., India, and Brazil. Leveraging more than 20 years of experience, PRIDE has enhanced its core competency of IT staffing services by creating client-centric, cost-effective IT, and business process solutions. PRIDE serves Client-Partners in the healthcare, IT, financial services, retail and insurance industries offering both Direct Hire and Temporary Staff of Healthcare Professionals, Vendor Management Systems, IT Hardware Procurement Services, and Business Processing Outsourcing. Temporary, Contract, Per Diem & Direct Hire staffing solutions are only part of what we can offer our clients. We work with our Client-Partners to customize workforce solutions and provide a value-add beyond traditional staffing. Exciting options such as: VMS: Manage order distribution, consolidate billing, and enhanced reporting capability that outperforms manual systems and processes. BPO: Increased flexibility in resource management and reduced response times to environmental changes; freeing our Client-Partners to focus on their core competencies.
About the job
Pride Health is hiring a DRG Validation RN Auditor! (REMOTE)
Schedule: Monday-Friday between 7am to 6pm EST
Contract: 5 months contract to hire
Pay Rate: 40-43/hour
Job Responsibilities
- Conduct MS-DRG and APR-DRG coding reviews to verify the accuracy of DRG assignment and reimbursement with a focus on overpayment identification
- Expert knowledge of and the ability to: identify the ICD-10-CM/PCS code assignment, appropriate code sequencing, present on admission (POA) assignment, and discharge disposition, in accordance with CMS requirements, ICD-10 Official Guidelines for Coding and Reporting, and AHA Coding Clinic guidance
- Must be fluent in the application of current ICD-10 Official Coding Guidelines and AHA Coding Clinic citations, in addition to demonstrating working knowledge of clinical criteria documentation requirements used to successfully substantiate code assignments
- Perform clinical coding review to ensure accuracy of medical coding and utilizes clinical expertise and judgment to determine correct coding and billing
- Solid command of anatomy and physiology, diagnostic procedures, and surgical operations developed from specialized training and extensive experience with ICD-10-PCS code assignment
- Writes clear, accurate and concise rationales in support of findings using ICD-10 CM/PCS Official Coding Guidelines, and AHA Coding Clinics
- Utilize proprietary workflow systems and encoder tool efficiently and accurately to make audit determinations, generate audit rationales and move claims through workflow process correctly
- Demonstrate knowledge of and compliance with changes and updates to coding guidelines, reimbursement trends, and client processes and requirements
- Maintain and manages daily case review assignments, with a high emphasis on quality
- Provide clinical support and expertise to the other investigative and analytical areas
- Will be working in a high-volume production environment that is matrix driven
- You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
- Unrestricted RN (registered nurse)
- CCS/CIC or will obtain within 6 months of hire
- 3+ years of MS DRG/APR DRG coding experience in a hospital environment with expert knowledge of ICD-10 Official Coding Guidelines and DRG reimbursement methodologies
- Expert knowledge of ICD-10-CM coding including but not limited to: expert knowledge of principal diagnosis selection, complications/comorbidities (CCs) and major complications/comorbidities (MCCs), and conditions that impact severity of illness (SOI) and risk of mortality (ROM)
- Expert knowledge of ICD-10-PCS coding including but not limited to: expert knowledge of the structural components of PCS including but not limited to: selection of appropriate body systems, root operations, body parts, approaches, devices, and qualifiers
How to Apply:
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