DRG Clinical Validation Nurse

This is a fully remote position, open to applicants in United States.

📋 Description

• Conduct clinical validation by verifying that diagnosis codes billed by the provider are substantiated within the medical record.

• Capable of interpreting clinical guidelines and criteria to apply them effectively during clinical reviews.

• Strong knowledge of anatomy and physiology, along with diagnostic and surgical procedures, acquired through specialized training and extensive experience with ICD-10-PCS code assignments.

• Exhibits the ability to accurately interpret the medical record.

• Produces clear, precise, and concise rationales to support findings.

• Oversees and manages case reviews with a strong focus on quality.

• Demonstrates the capability to operate in a high-volume production environment.

• Familiarity with health insurance operations, industry terminology, and regulatory guidelines.

⛳️ Requirements

• At least two years of experience in clinical validation within a payment integrity environment is required.

• Candidates with nursing backgrounds in inpatient claims auditing or case management may also be considered.

• Unrestricted Registered Nurse with an active RN license is required.

• CCS (Certified Coding Specialist) or CIC (Certified Inpatient Coder) certification is preferred.

• CCDS or CDIP Certification is preferred.

• Proficient knowledge of ICD-10 coding.

• Basic understanding of DRG validation and coding.

• Ability to operate a Windows PC and utilize multiple applications simultaneously.

🏝️ Benefits

• Healthcare that suits your needs - We provide outstanding medical, dental, and vision plan options that cover employees and their dependents.

• 401(k) with Employer Match - Join us, and we will invest in your future.

• Generous Paid Time Off - Accrued PTO starting from day one, in addition to extra days off for illness and holidays.

• Wellness - We prioritize your well-being. From Commuter Benefits to FSAs, we ensure you are covered.

• Learning & Development - We are committed to your growth as a professional through ongoing education, mentorship, and our investment in LinkedIn Learning.