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DRG Clinical Validation Nurse

MedReview

Role overview

Qualifications

  • Minimum of two years’ experience in clinical validation in a payment integrity setting required
  • Unrestricted Registered Nurse with active RN licensure required
  • CCS (Certified Coding Specialist) or CIC (Certified Inpatient Coder) certification preferred
  • Knowledge of ICD-10 coding

Responsibilities

  • Perform clinical validation by ensuring diagnosis codes billed by the provider are supported within the medical record
  • Must be able to interpret clinical guidelines/criteria and apply to clinical review
  • Demonstrates the ability to accurately interpret the medical record
  • Writes clear, accurate and concise rationales in support of findings

About the company

MedReview logo

MedReview

Hospitals & Health Care

MedReview is One of the Leading Medical Claims Auditors in the Country . Our Medical Claims Audits, Pharmacy Audits and Dependent Eligibility Audits Help Self Insured Plan Sponsors Reduce Their Healthcare Costs. Organizations that self insure their health plans are experiencing double digit cost increases. Health plan costs are now one of their largest operating expenses. MedReview's medical claims audits and our dependent eligibility audit programs will help you control your self insured plan's expenses and will result in a positive contribution to your organization's bottom line. MedReview's medical claims audits will also help you comply with ERISA, Sarbanes-Oxley and other regulatory requirements that mandate you act in the best interests of your plan's participants.

Company details

IndustryHospitals & Health Care
Company size51 - 200

Links

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Job description

Position Summary
At MedReview, our mission is to bring accuracy, accountability, and clinical excellence to healthcare.  As such, we are a leading authority in payment integrity solutions including DRG Validation, Cost Outlier and Readmission reviews. We are seeking a registered nurse with experience in clinical validation to work within our coding department.  
Candidate should be highly motivated, with strong clinical and coding background. This individual must have excellent communication skills and an analytical mindset to achieve and maintain high-level performance in a fast-paced environment.
This is a fulltime position (40 hours per week) Monday – Friday. You’ll enjoy the flexibility to telecommute from anywhere within the United States. Training will be conducted virtually from your home.
If you are interested in this role with MedReview, please let us know. Here is what we are searching for:

Responsibilities:
 
  • Perform clinical validation by ensuring diagnosis codes billed by the provider are supported within the medical record
  • Must be able to interpret clinical guidelines/criteria and apply to clinical review
  • Solid understanding of anatomy and physiology, diagnostic and surgical procedures developed from specialized training and extensive experience with ICD-10-PCS code assignments
  • Demonstrates the ability to accurately interpret the medical record
  • Writes clear, accurate and concise rationales in support of findings
  • Maintains and manages case reviews with a high emphasis on quality
  • Demonstrates the ability to work in a high – volume production environment
  • Knowledge of health insurance business, industry terminology, and regulatory guidelines 

Qualifications:
 
  • Minimum of two years’ experience in clinical validation in a payment integrity setting required
  • May consider nurses with inpatient claims auditing experience or case management experience.
  • Unrestricted Registered Nurse with active RN licensure required
  • CCS (Certified Coding Specialist) or CIC (Certified Inpatient Coder) certification preferred
  • CCDS or CDIP Certification preferred
  • Knowledge of ICD-10 coding
  • Basic Knowledge of DRG validation and coding
  • Ability to use Windows PC with the ability to utilize multiple applications at the same time

Remote Work Requirements
 
  • High speed internet (100 Mbps per person recommended) with secured WIFI.
  • A dedicated workspace with minimal interruptions to protect PHI and HIPAA information.
  • Must be able to sit and use a computer keyboard for extended periods of time.

Benefits and perks include:
 
  • Healthcare that fits your needs - We offer excellent medical, dental, and vision plan options that provide coverage to employees and dependents.
  • 401(k) with Employer Match - Join the team and we will invest in your future
  • Generous Paid Time Off - Accrued PTO starting day one, plus additional days off when you’re not feeling well, to observe holidays.
  • Wellness - We care about your well-being. From Commuter Benefits to FSAs, we’ve got you covered.
  • Learning & Development - Through continued education/mentorship on the job and our investment in LinkedIn Learning, we’re focused on your growth as a working professional.

Salary Rate: $85,000 – 95,000/Annually.
 

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MR

Marcus Rivera

Chief Revenue Officer

m.rivera@company.com
linkedin.com/in/marcusrivera
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