Dieses Stellenangebot ist nicht mehr verfügbar
Remote MSDRG Auditor
CGI Njoyn
- Atlanta, Georgia, United States
- Atlanta, Georgia, United States
Über
Title
Remote MSDRG Auditor
Category
Analytics and Emerging Digital Technologies
City
Atlanta, Georgia, United States
Position Description The DRG Validation Auditor is a member of the CGI Healthcare Compliance, DRG Validation Team, with responsibility for reviewing medical records to determine the accuracy of coding and reimbursement for clinical services rendered to beneficiaries of health plans, including Commercial and Government clients.
Auditors are charged with rendering appropriate, well-supported, and thoroughly-documented decisions that identify improper payments (overpayments and underpayments) on paid claims on behalf of the client from various providers of clinical services, including acute care, long‑term acute care, acute rehabilitation, skilled nursing facilities, and other provider types and care settings.
The role is prepared for through a detailed training process that covers review methods, coding guidelines, documentation formats, and the client’s specific requirements. Ongoing training and education are provided on audit processes, coding and reimbursement changes, and other relevant topics.
Work may result in changes to the payment for previously‑rendered services. Auditors must incorporate coding experience and knowledge, exercise critical thinking, and render decisions through a well‑defined process. The DRG Validation Auditor reports to a DRG Validation Team Leader who provides support, feedback, and guidance. Audit performance review and quality assurance are delivered through a structured review and quality‑management program.
Location: The position can be located remotely anywhere in the United States.
Schedule: Candidates must be willing to work in Eastern Time Zone hours.
Responsibilities
Review inpatient medical records to validate assignment and sequencing of ICD‑10 diagnosis and procedure codes, discharge status codes, Hospital Acquired Conditions (HACs), POA assignment, and DRG assignment.
Provide a detailed rationale for every medical record review resulting in a DRG Review Results letter, including supporting references.
Follow proper procedure for referral to Clinical Nurse Auditor or Physician Advisor, as applicable.
Utilize proper reference material, standards, and guidelines for coding.
Provide input to the Edit Development team on claims selection criteria.
Verify data received from the client and work to resolve discrepancies.
When onsite review is required, interact with providers and other personnel in a professional manner.
Follow CGI policies and processes, completing Red Carpet, timesheets, payroll, travel expense documents, and other corporate requirements in a timely manner.
Communicate timely with the Team Lead regarding illnesses, appointments, vacation requests, changes in work schedule, performance barriers, and computer issues.
Comply with department standards regarding productivity and audit quality.
Perform other duties as assigned.
Required Qualifications
Credentials: Current AHIMA credentials (RHIT, RHIA, or CCS), with CCS preferred.
Experience: Minimum five (5) years of inpatient coding experience. Extensive knowledge of ICD‑10‑CM/PCS coding and DRG reimbursement. Experience training or mentoring junior‑level coders is highly desired.
Methodology: Understand government and commercial provider reimbursement methodologies (MS‑DRG and APR‑DRG) and possess strong clinical validation and data analytic skills.
Technical Skills: Working knowledge of Microsoft Office (Outlook, Word, Excel) and Windows operating systems.
Communication: Ability to write a well‑reasoned review in a narrative style, with accurate spelling, grammar, punctuation, and sentence structure.
Core Competencies: Adapt to changing priorities to meet client requirements, and meet department productivity standards and deadlines.
Attributes: Proactive, self‑directed, self‑sufficient, detail‑oriented, and passionate about lifelong learning.
Travel: May be required for additional training and onsite reviews on an as‑needed basis.
Compensation Range Estimated compensation range: $58,000.00 – $114,900.00.
Benefits
Competitive compensation
Comprehensive insurance options
Matching contributions through the 401(k) plan and the share purchase plan
Paid time off for vacation, holidays, and sick time
Paid parental leave
Learning opportunities and tuition assistance
Wellness and well‑being programs
Equal Employment Opportunity Statement Qualified applicants will receive consideration for employment without regard to their race, ethnicity, ancestry, color, sex, religion, creed, age, national origin, citizenship status, disability, pregnancy, medical condition, military and veteran status, marital status, sexual orientation or perceived sexual orientation, gender, gender identity, gender expression, familial status or responsibilities, reproductive health decisions, political affiliation, genetic information, height, weight, or any other legally protected status or characteristics to the extent required by applicable federal, state, and/or local laws where we do business.
CGI provides reasonable accommodations to qualified individuals with disabilities. If you need an accommodation to apply for a job in the U.S., please email the CGI U.S. Employment Compliance mailbox at US_Employment_Compliance@cgi.com. You will need to reference the Position ID of the position in which you are interested. Your message will be routed to the appropriate recruiter who will assist you.
All CGI offers of employment in the U.S. are contingent upon the ability to successfully complete a background investigation. Background investigation components can vary dependent upon specific assignment and/or level of U.S. government security clearance held. Depending on role and/or federal government security clearance requirements, and in accordance with applicable laws, some background investigations may include a credit check. CGI will consider for employment qualified applicants with arrests and conviction records in accordance with all local regulations and ordinances.
CGI will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with CGI’s legal duty to furnish information.
#J-18808-Ljbffr
Sprachkenntnisse
- English
Hinweis für Nutzer
Dieses Stellenangebot wurde von einem unserer Partner veröffentlicht. Sie können das Originalangebot einsehen hier.