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Clinical Review Assistant Jobs (NOW HIRING)

CERiS

Clinical Review Auditor I

Fort Worth, TX · On-site

$70K - $107K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

The Clinical Auditor will review medical records to determine accuracy of billing through ... Working knowledge of HIPAA Privacy and Security Rules * Assist Quality Control team and medical ...

Corvel

Clinical Review Auditor I

Fort Worth, TX · On-site

$70K - $107K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

The Clinical Auditor will review medical records to determine accuracy of billing through ... Working knowledge of HIPAA Privacy and Security Rules * Assist Quality Control team and medical ...

Cooper University Hospital

Clinical Review RN PRN

Camden, NJ

$61/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Utilizes Payer specific screening tools as a resource to assist in the determination process ... review preferred. Knowledge and understanding of disease protocols and clinical pathways for ...

Cooper University Hospital

Clinical Review RN PRN

Camden, NJ · On-site

$61/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Utilizes Payer specific screening tools as a resource to assist in the determination process ... review preferred. Knowledge and understanding of disease protocols and clinical pathways for ...

Cooper University Hospital

Clinical Review RN PRN

Camden, NJ

$37 - $61/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Utilizes Payer specific screening tools as a resource to assist in the determination process ... review preferred. Knowledge and understanding of disease protocols and clinical pathways for ...

CloudFactory Limited

$76 - $103/hr

Review de-identified ICU clinical notes and EHR data related to patients with Sepsis. * Apply ... or Physician Assistant (PA) * Strong understanding of clinical terminology and medical ...

New

Cooper University Hospital

Clinical Review RN PRN

Camden, NJ · On-site

$61/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Utilizes Payer specific screening tools as a resource to assist in the determination process ... review preferred. Knowledge and understanding of disease protocols and clinical pathways for ...

Medica

Supervisor, Clinical Quality Review

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Key Accountabilities * Assist Manager with supporting an efficient department operation and ... Oversees clinical review readiness for audits including documentation standards, reviewer training ...

Corvel

Clinical Review QC Auditor

Fort Worth, TX · On-site +1

$68K - $104K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... clinical/coding) reviews of medical records and/or other documentation. This role will determine ... Working knowledge of HIPAA Privacy and Security Rules * Assist Quality Control team and medical ...

CERiS

Clinical Review QC Auditor

$68K - $104K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... clinical/coding) reviews of medical records and/or other documentation. This role will determine ... Working knowledge of HIPAA Privacy and Security Rules * Assist Quality Control team and medical ...

CERiS

Clinical Review QC Auditor

Fort Worth, TX · Remote

$68K - $104K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... clinical/coding) reviews of medical records and/or other documentation. This role will determine ... Working knowledge of HIPAA Privacy and Security Rules * Assist Quality Control team and medical ...

Corvel

Clinical Review QC Auditor

$68K - $104K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... clinical/coding) reviews of medical records and/or other documentation. This role will determine ... Working knowledge of HIPAA Privacy and Security Rules * Assist Quality Control team and medical ...

CERiS

Clinical Review QC Auditor

Fort Worth, TX · On-site +1

$68K - $104K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... clinical/coding) reviews of medical records and/or other documentation. This role will determine ... Working knowledge of HIPAA Privacy and Security Rules * Assist Quality Control team and medical ...

TEEMA Group

Clinical Quality Review Nurse

Phoenix, AZ · Remote

$41 - $44/hr

Analyze trends and assist in identifying patterns in care delivery and outcomes * Collaborate with clinical leadership, including Medical Directors, to review findings * Participate in quality ...

Corvel

Clinical Review QC Auditor

Fort Worth, TX · Remote

$68K - $104K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... clinical/coding) reviews of medical records and/or other documentation. This role will determine ... Working knowledge of HIPAA Privacy and Security Rules * Assist Quality Control team and medical ...

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Clinical Review Auditor I

CERiS

Fort Worth, TX • On-site

$70K - $107K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 29 days ago

Job 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. This involves completing medical record reviews, accurately documenting findings and non-findings and providing clinical/policy/regulatory support for the determination. This role will utilize their experience with ICD-10-CM & PCS coding guidelines, the ability to understand modern pharmacology, disease management and clinical intervention procedures. The ideal DRG Clinical Auditor candidate has strong written and verbal communication skills, clinical knowledge of disease processes, and knowledge of medical necessity rules.
ESSENTIAL FUNCTIONS & RESPONSIBILITIES:
  • The Clinical Auditor will review medical records to determine accuracy of billing through verification of coding and review of supporting clinical documentation
  • Conduct audits to ensure accurate reimbursement and identifying potential savings
  • Demonstrated knowledge of ICD-10-CM codes, PCS and DRG coding, understanding of payer rules and regulations, including Medicare and Medicaid
  • Understand and comply with all internal and external policies
  • Working knowledge of HIPAA Privacy and Security Rules
  • 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

KNOWLEDGE & SKILLS:
  • 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

EDUCATION & EXPERIENCE:
  • LVN or RN license in the state of employment preferred
  • CCS or CIC required with DRG auditing experience in ICD-10-CM, ICD-10 PCS
  • Experience in the OR, ICU, or ER as an RN highly preferred

PAY RANGE:
CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.
For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.
Pay Range: $70,143 - $107,253
A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management
In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.
ABOUT CERIS:
CERIS, a division of CorVel Corporation, a certified Great Place to Work® Company, offers incremental value, experience, and a sincere dedication to our valued partners. Through our clinical expertise and cost containment solutions, we are committed to accuracy and transparency in healthcare payments. We are a stable and growing company with a strong, supportive culture along with plenty of career advancement opportunities. We embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).
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, and paid time off.
CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.
#LI-Remote
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.
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About CERIS

Sourced by ZipRecruiter

Industry

Health care and social assistance

Company size

51 - 200 Employees

Headquarters location

Fort Worth, TX, US

Year founded

1990

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