An active RN professional license in good standing
Clinical practice experience
Coding certification in good standing (e.g., CCS, CIC)
Coding validation/auditing experience
Requirements:
Utilize coding guidelines and clinical guidelines to perform DRG or APC validation
Validate principal diagnosis, secondary diagnoses, sequencing of diagnoses, discharge statuses and procedures utilizing the medical record
Evaluate short stay claims for medical necessity of an inpatient level of care
Apply CPT and ICD-10 guidelines
Job description
TREND Health Partners is a tech-enabled payment integrity company. Our mission is to facilitate collaboration between payers and providers for mutual benefit and waste reduction, ultimately improving access to healthcare. We achieve this by aligning the common goals of payers and providers and fostering collaboration through a shared technology platform and seamless workflows.
Joining TREND Health Partners means becoming part of a dynamic, growing organization that promotes a collaborative and innovative work environment. Our comprehensive compensation package includes competitive salaries, highly valued health insurance, a 401(k) plan with employer match, paid parental leave, and more.
The Nurse Coder DRG Auditor’s primary responsibility is to review medical records and associated claim information to validate accuracy of DRG assignments, APC assignments and/or medical necessity for inpatient level of care. This role will apply coding and clinical principles based on industry standards and company/client guidelines.
Role and Responsibilities
Utilize coding guidelines and clinical guidelines to perform DRG or APC validation
Validate principal diagnosis, secondary diagnoses, sequencing of diagnoses, discharge statuses and procedures utilizing the medical record
Evaluate short stay claims for medical necessity of an inpatient level of care
Apply CPT and ICD-10 guidelines
Apply policies, procedures, guidelines and regulations developed by Centers for Medicare and Medicaid Services (CMS), commercial payers, InterQual, MCG, and Trend Health Partners
Provide appeal responses for claims of the above types utilizing industry standards and company/client policies
Assist with new concept development
Assist with claim selection criteria
Assist with itemized bill review as needed
Maintain licensures, certifications and continuing education requirements
May require client communication to support findings
Qualifications
An active RN professional license in good standing
Clinical practice experience
Coding certification in good standing. Examples: CCS, CIC
Coding validation/auditing experience
Well-developed verbal and written communication skills coupled with recognizable organization
Ability to effectively prioritize tasks
Microsoft Office experience, specifically Excel
Preferred Skills
Appeals experience a plus
APR-DRG experience a plus
Client communication experience a plus
Concept development experience a plus
Claim selection experience a plus
Experience with machine learning/artificial intelligence a plus
Case Management and/or Utilization Review experience a plus
Clinical Documentation Improvement experience a plus
Itemized bill validation experience a plus
Quality Assurance experience a plus
Management experience a plus
Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) a plus
TruCode/TruBridge, 3M, WebStrat or similar experience a plus
Mental and Physical Demands
This position will be exposed mainly to an indoor office environment and will be expected to work in or around computers and printers.
The nature of the work is sedentary, and the employee will be sitting most of the time.
Essential physical functions of the job include typing and the repetitive motion to utilize computer software and hardware continuously throughout the day.
Essential mental functions of this position include concentrating on analytical tasks, reading information, and verbal/written communication to others continuously throughout the day.
Related duties as assigned
This job description documents the general nature and level of work but is not intended to be a comprehensive list of activities, duties, or responsibilities required for this position. Consequently, employees may be asked to perform other duties as required.
Employees may also be asked to complete certain compliance requirements set forth by our Business Partners in the performance of their jobs including but not limited to requests for background and drug screenings and disclosures of personal health information or personally identifiable information. Exemptions as provided under the ADA and TITLE VII of the Civil Rights Act will be observed and followed.
Reasonable accommodations may be made to enable individuals with disabilities to perform the functions outlined above.
