DRG Auditor

US-MA-Woburn
3 months ago
Job ID
2017-1020
# of Openings
1
Category
Auditor

Overview

A leader and innovator in healthcare cost containment, OmniClaim is a rapidly-growing company that provides a wide range of pre- and post-payment cost containment services designed to ensure that its insurance company clients are not overpaying on claims. As the industry leader in healthcare cost containment, the company’s disciplined approach, state of the art predictive analytics software, and fanatical focus on customer service are saving healthcare payers millions of dollars every month. We offer an entrepreneurial, high energy work environment, very competitive salaries and benefits commensurate with experience and an on-site café and workout facility.

Responsibilities

DRG Auditors will review full medical records (electronic and hard copy) for DRG validation at hospitals across the country to identifying cases of “up-coding.” Once overpayments are identified, the auditor oversees the well-documented process through which insurance companies recover overpayments.  The Auditor will work collaboratively as part of elite team of auditors, schedulers, office support and management, supporting and learning from each other.  This is a virtual opportunity and can be located anywhere in the United States. 

Qualifications

  • LPN and/or RN degree in nursing
  • CCS, CPC or equivalent certification
  • 5-10 years extensive experience coding in a tertiary inpatient hospital setting and be familiar with “Coding Clinics.”
  • Advanced knowledge in ICD-10-CM and PCS coding methodologies.
  • Thorough understanding of 3M Encoder/grouper logic or similar billing software products is essential.
  • Comprehensive knowledge of MS-DRG, APR, and AP DRG logic.
  • Experience defending insurance company appeals of DRG coding.
  • Coding auditing experience a plus.
  • Maintains strict patient and physician confidentiality and follows all federal, state and hospital guidelines for release of information.
  • Excellent oral and written communication, organizational and time management skills
  • Ability to develop relationships at all levels.
  • Demonstrated proficiency in basic computer skills e., Microsoft Windows, Outlook, Word, Excel.
  • Must be able to travel 50% of the work year locally, regionally or nationally to different client sites.

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