DRG Coding Auditor

The DRG Coding Auditor position has an extensive background in facility-based coding practices, clinical documentation, and/or inpatient coding auditing. This person should have a high level of understanding of reimbursement guidelines, specifically around the billing practices using MS-DRG, APR-DRG, and Itemized Bill Reviews (IBR). This position is responsible for auditing inpatient medical records to evaluate issues of coding and DRG assignment accuracy to generate high-quality, recoverable claims for the benefit of our clients.

Why choose ClarisHealth? - ClarisHealth unites data and people through innovative technology. - Remote-first flexible working environment - OUR AMAZING BENEFITS - Health insurance, including $0 premium HDHP and $0 deductible PPO options. FIRST-DAY COVERAGE! - Company-paid Short-term disability and Life Insurance. - Generous Paid Time Off: 4 weeks' Vacation, 1 week Wellness Time, 2 days volunteer time off, 9 holidays, 2 floating holidays - 401(k) with matching, IMMEDIATE vesting - “Got Your Back” environment - We work hard, but we know how to take time and enjoy life

YOU MAY BE IDEAL IF YOU HAVE - 3+ years of performing inpatient acute care hospital coding (may substitute equivalent years of DRG validation experience) OR 3+ years of Clinical Documentation Improvement experience (coding OR auditing) - CCS or CIC certification. - Experience with ICD-10 CM and DRG coding. - Positive, self-motivated, driven, and teachable attitude. - High standard of personal integrity and accountability. - Passion and aptitude for solving complex problems. - Fun attitude and great sense of humor!

The essential functions include, but are not limited to, the following: - Investigate, review, and provide coding expertise in the application of medical and reimbursement policies within the claim adjudication process through document review. - Perform clinical coverage review of claims, which requires interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies, coding requirements and consideration of relevant clinical information on claims with aberrant billing patterns. - Perform clinical coding review to ensure accuracy of medical coding and utilize clinical expertise and judgment to determine correct coding and billing. - Knowledge of and the ability to: identify the ICD-10-CM/PCS code assignment, code sequencing, and discharge disposition, in accordance with CMS requirements, Official Guidelines for Coding and Reporting, and Coding Clinic guidance. - Must be fluent in application of current Official Coding Guidelines and Coding Clinic citations, in addition to demonstrating working knowledge of clinical criteria documentation requirements used to successfully substantiate code assignments. - 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. - Maintain and manage 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.

For more information on our culture and employment opportunities, please visit us at https://www.clarishealth.com/careers/. #GYB

Help develop the industry-leading solution for the healthcare payer market. Join our team at ClarisHealth in challenging the traditional paper-based, time- and labor-intensive audit and data mining methods and make an impact on the evolution of claims payment recovery.

ClarisHealth is the answer to the health plan industry’s siloed solutions and traditional models for identification and overpayment recovery services. Founded in 2013, we provide health plans and payers with total visibility into payment integrity operations through our advanced cost containment technology Pareo®. Pareo enables health plans to maximize avoidance and recoveries at the most optimized cost for a 10x return on their software investment. Currently, nearly 33 million lives are served by our total payment integrity platform.

ClarisHealth embraces a supportive working culture of creativity and innovation, termed internally as “Got Your Back.” We live out this #GYB spirit every day by leading with Compassion, Communicating with transparency, and committing to improving our Community.Applicants must be currently authorized to work in the United States on a full-time basis.

ClarisHealth is not able to sponsor applicants for work visas.

ClarisHealth is an Equal Opportunity Employer. Anyone needing accommodation to complete the interview process should notify the Director, People & Management.

EOE including Disability/Veterans