Sr Auditor TL, Clinical Validation at The Judge Group Inc. in Boston, Massachusetts

Job Description:

Location: REMOTE

Salary: $45.00 USD Hourly - $50.00 USD Hourly

Description: Job Opportunity: Inpatient Coding & Clinical Chart Validation Auditor




Join our team for a May 5th Class! (REMOTE)




Work Environment:

• Monday through Friday work schedule.


• Training Hours: Must be available for training between 8:00 AM and 4:00 PM Eastern Time (ET).


• Regular Work Hours: 8:00 AM ET - 4:30 PM ET. We offer flexibility with a later start time, permitting work hours up to 6:00 PM ET.

Are you a detail-oriented and experienced professional with a strong background in both clinical practice and inpatient coding/auditing? Do you possess a keen understanding of DRG assignment, clinical indicators, and the intricacies of inpatient billing? If so, we encourage you to apply for our Inpatient Coding & Clinical Chart Validation Auditor position.


This critical role will focus on conducting comprehensive audits of inpatient claims, ensuring coding accuracy, clinical appropriateness, and adherence to billing guidelines. You will leverage your expertise in Inpatient DRG/APR-DRG and episode of care to identify potential discrepancies and ensure compliant billing practices.



Key Responsibilities:

• 
  Analyzes and Audits Claims: Integrate medical chart coding principles, clinical guidelines, and objectivity to perform thorough medical audit activities. Utilize advanced ICD-10 coding expertise, clinical knowledge, and industry understanding to substantiate audit conclusions. This includes detailed medical record review and/or episode of care analysis. Perform work independently and efficiently.
• 
  Effectively Utilizes Audit Tools: Demonstrate a high level of proficiency in utilizing our proprietary auditing systems to make accurate audit determinations and generate comprehensive audit letters.
• 
  Meets or Exceeds Standards/Guidelines for Productivity: Consistently meet or exceed production goals established by the audit operations management team.
• 
  Meets or Exceeds Standards/Guidelines for Accuracy and Quality: Achieve and maintain the expected level of accuracy and quality in all audit work, including valid claim identification and clear, concise documentation (letter writing).
• 
  Identifies New Claim Types: Proactively identify potential claims outside the current audit scope where additional recoveries may be possible. Suggest and contribute to the development of high-quality, high-value process improvements and tools.
• 
  Other Duties: Complete all responsibilities as outlined in your annual Performance Plan, as well as any special projects or other duties as assigned.

Requirements:




Education (at least one of the following is required):

• Associate or Bachelor's degree in Nursing with an active and unrestricted license.
• Associate or Bachelor's degree in Health Information Management with either RHIA or RHIT certification.

Coding/CDI Certification (at least one of the following is required and must be maintained as a condition of employment):

• RHIA or RHIT
• CPC or COC
• Inpatient Coding Credential - CCS, CIC, CDIP, or CCDS

Experience (required):

• 5 to 7+ years of experience working with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG with a comprehensive understanding of medical claims billing/payment systems, provider billing guidelines, payer reimbursement policies, medical necessity criteria, and coding terminology.
• Demonstrated adherence to official coding guidelines, Coding Clinic determinations, and CMS and other regulatory compliance guidelines and mandates. Requires expert coding knowledge in DRG, APR-DRG, ICD-10, CPT, and HCPCS codes.
• Working knowledge of and applicable industry-based standards.
• Proficiency in Microsoft Word, Access, Excel, TEAMS, and other relevant applications.
• Excellent written and verbal communication skills.

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Contact: bduke@judge.com


This job and many more are available through The Judge Group. Find us on the web at www.judge.com Apply Now