Georgia Employer AUDITOR CLINICAL VALIDATION in Atlanta, Georgia
Description Remote DRG / Clinical Validation Auditor (Work from home) The Auditor, DRG Coding & Clinical Validation position has an extensive background in nursing, inpatient coding and reimbursement guidelines and specifically has a solid understanding of the MS-DRG, AP-DRG and APR-DRG payment systems. This position is responsible for auditing client data and generating high quality recoverable claims for the benefit of Cotiviti and our clients. Responsible for performing clinical reviews of medical records and other documentation to evaluate issues of coding accuracy, medical necessity, and the appropriateness of treatment setting and services delivered. Primarily responsible for auditing efforts by executing projects assigned by the Director, Audit Operations or Manager, Audit Operations. Displays professional skepticism that enhances the work performed in order to achieves success in position. Key Responsibilities * Identifies and Enters Claims. Integrates medical chart coding principles and objectivity in performance of medical audit activities. Draws on advanced ICD-9 and ICD-10 coding expertise and industry knowledge to substantiate conclusions. Performs work independently, reviews and interprets medical records and applies in-depth knowledge of coding principles to determine potential billing/coding issues, and quality concerns. * Effectively Utilizes Audit Tools. Utilizes with advanced proficiency, Cotiviti and client tools required to perform duties. Enters the claim into Cotiviti system accurately and in accordance with standard procedures. Updates current reports, develops and runs custom queries and validates accuracy of current reports used. Makes determinations based on prior knowledge, experience of client contract terms with the likelihood of recovery acceptance. * Meets or Exceeds Standards/Guidelines for Productivity. Maintains production goals and quality standards set by the audit for the auditing concept. Audits against the expected level of quality and quantity (i.e. hit rate, # claims written, ID per hour). * Meets or Exceed Standards/Guidelines for QualityAll qualified applicants will receive consideration for employment without regard to race, color, religion, sex, or national origin. We are also an equal opportunity employer of individuals with disabilities and protected veterans. Please view Equal Employment Opportunity Posters provided by OFCCP here.Employer's Job# 17-1337Please visit job URL for more information about this opening and to view EOE statement..