Nurse Inpatient Coding Auditor, CIC or CCS certified

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

📋 Description

• Conduct clinical assessments of medical records and related documentation to verify the accuracy of claims coding, medical necessity, and the appropriateness of treatment settings and services provided.

• Report directly to the Payment Assurance Manager.

• Audit and evaluate neonatal intensive care unit (NICU) claims in accordance with ICD-10 coding standards and clinical guidelines.

• Analyze claims data to enhance reimbursement by ensuring that diagnosis codes, procedure codes, and supporting documentation accurately reflect the services delivered.

• Ensure that claims analysis adheres to ethical coding standards, guidelines, and regulatory requirements.

• Utilize Clinical Review Tools and EMR Systems effectively.

• Investigate reimbursement regulations to ensure claim payment compliance and to substantiate audit outcomes.

• Assist in the creation of documentation for claims audit processes, including workflow diagrams, policies and procedures, and standard operating procedures.

• Identify inconsistencies in provider billing and recommend modifications to guarantee accurate reimbursement.

• Foster a culture and work environment that encourages continuous improvement concerning products and services.

⛳️ Requirements

• A Registered Nurse license is required.

• A minimum of 2 years of experience with inpatient claims, preferably in NICU and maternity, is required.

• Inpatient Coding Certification (CCS or CIC) is required.

• If not currently certified, the candidate must obtain either CIC or CCS within 6 months of hire.

• The applicant is responsible for exam and associated fees.

• Experience in nursing, inpatient coding, and reimbursement guidelines is necessary.

• A solid understanding of the MS-DRG, AP-DRG, and APR-DRG payment systems is essential.

• At least 2 years of experience working with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG is required.

• A comprehensive knowledge of medical claims billing/payment systems, provider billing guidelines, payer reimbursement policies, medical necessity criteria, and coding terminology is important.

• Compliance with official coding guidelines, coding clinic determinations, and CMS and other regulatory compliance standards and mandates is crucial.

• Expert knowledge of coding, including DRG, ICD-10, CPT, and HCPCS codes, is required.

• Experience with appeals is highly preferred.

• Exceptional communication skills, both verbal and written, are necessary.

• Strong interpersonal skills that foster collaborative teamwork are essential.

• Proficiency in Microsoft Office applications: Word and Excel; Access is highly preferred.

• Capability to work independently as well as part of a team.

• Strong critical listening, thinking, decision-making, and problem-solving skills are required.

🏝️ Benefits

• Paid Time Off.

• Paid Parental Leave.

• Medical, dental, and vision benefits.

• 401K plan with company match.

• Short- and Long-Term Disability coverage.

• Group Life Insurance.

• Tuition reimbursement.

• Opportunities for professional development.

• A Business Casual work environment.