DRG Clinical Validation Nurse

MedReviewNew York, NY, US

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Job Description

Position Summary

At MedReview, our mission is to bring accuracy, accountability, and clinical excellence to healthcare. As such, we are a leading authority in payment integrity solutions including DRG Validation, Cost Outlier and Readmission reviews. We are seeking a registered nurse with experience in clinical validation to work within our coding department.

Candidate should be highly motivated, with strong clinical and coding background. This individual must have excellent communication skills and an analytical mindset to achieve and maintain high-level performance in a fast-paced environment.

This is a fulltime position (40 hours per week) Monday – Friday. You’ll enjoy the flexibility to telecommute from anywhere within the United States. Training will be conducted virtually from your home.

If you are interested in this role with MedReview, please let us know. Here is what we are searching for :

Responsibilities :

Perform clinical validation by ensuring diagnosis codes billed by the provider are supported within the medical record
Must be able to interpret clinical guidelines / criteria and apply to clinical review
Solid understanding of anatomy and physiology, diagnostic and surgical procedures developed from specialized training and extensive experience with ICD-10-PCS code assignments
Demonstrates the ability to accurately interpret the medical record
Writes clear, accurate and concise rationales in support of findings
Maintains and manages case reviews with a high emphasis on quality
Demonstrates the ability to work in a high – volume production environment
Knowledge of health insurance business, industry terminology, and regulatory guidelines

Qualifications :

Minimum of two years’ experience in clinical validation in a payment integrity setting required

May consider nurses with inpatient claims auditing experience or case management experience.

Unrestricted Registered Nurse with active RN licensure required

CCS (Certified Coding Specialist) or CIC (Certified Inpatient Coder) certification preferred

CCDS or CDIP Certification preferred

Knowledge of ICD-10 coding

Basic Knowledge of DRG validation and coding

Ability to use Windows PC with the ability to utilize multiple applications at the same time

Remote Work Requirements

High speed internet (100 Mbps per person recommended) with secured WIFI.

A dedicated workspace with minimal interruptions to protect PHI and HIPAA information.

Must be able to sit and use a computer keyboard for extended periods of time.

Benefits and perks include :

Healthcare that fits your needs - We offer excellent medical, dental, and vision plan options that provide coverage to employees and dependents.

401(k) with Employer Match - Join the team and we will invest in your future

Generous Paid Time Off - Accrued PTO starting day one, plus additional days off when you’re not feeling well, to observe holidays.

Wellness - We care about your well-being. From Commuter Benefits to FSAs, we’ve got you covered.

Learning & Development - Through continued education / mentorship on the job and our investment in LinkedIn Learning, we’re focused on your growth as a working professional.

Salary Rate : $85,000 – 95,000 / Annually.

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Clinical Validation • New York, NY, US