[Hiring] Clinical Review QC Auditor @CorVel Career Site

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Diagnostic Related Groups (DRG) Clinical Auditor will be responsible for performing DRG validation (clinical/coding) reviews of medical records and/or other documentation. This role will determine correct DRG/coding as defined by review methodologies specific to the type of review. • Complete medical record reviews • Accurately document findings and non-findings • Provide clinical/policy/regulatory support for the determination • Review medical records to determine accuracy of billing through verification of coding and review of supporting clinical documentation • Check for physician's notes supporting the DRGs assigned • Conduct audits to ensure accurate reimbursement and identify potential savings • Review previously conducted audits to ensure accurate coding and identify potential savings • Review all opportunities sent to the customers for complete and correct information • Demonstrate knowledge of ICD-10-CM codes, PCS and DRG coding • Understand and comply with all internal and external policies • Assist Quality Control team and medical director with appeals, rebuttals, etc. • Notify leadership of any issues or concerns in a timely manner • Additional duties as assigned Qualifications • Expert knowledge of application of current Official Coding Guidelines and Coding Clinic citations • Solid knowledge and understanding of clinical criteria documentation requirements used to successfully substantiate code assignments • Proficient understanding of Medicare, CMS guidelines and ICD-10 coding guidelines • Effective and professional communication skills, both verbal and written • Ability to work independently and in a team environment • High attention to detail • Must possess critical thinking skills • Ability to multi-task and assist with team coverage and provide support when needed • Ability to build relationships both internally and externally • Ability to work in a fast-paced environment • Demonstrated proficiency in basic computer skills and typing • Proficiency with Microsoft Office • Proficient in both MS and APR DRG methodology preferred Requirements • LVN or RN license in the state of employment preferred • Experience in the OR, ICU, or ER as an RN highly preferred • Required minimum of 2 years of recent DRG Quality Auditing experience in a hospital setting, or health plan • National Coding Certification required through either AHIMA (preferred) or AAPC • Extensive hands-on ICD-10 CM / PCS experience required Pay Range Pay Range: $68,566 – $104,841 Benefits A comprehensive benefits package is available for full-time regular employees and includes: • Medical (HDHP) w/Pharmacy • Dental • Vision • Long Term Disability • Health Savings Account • Flexible Spending Account Options • Life Insurance • Accident Insurance • Critical Illness Insurance • Pre-paid Legal Insurance • Parking and Transit FSA accounts • 401K • ROTH 401K • Paid time off Apply tot his job Apply tot his job