Salary:
Disclaimer: This is a 1099 independent contractor position requiring a minimum commitment of 30 hours per week. The contract term is one year, with the option to renew.
Role and Responsibilities
TheDRG ValidationAuditoris avalued member ofthePenstockAuditteam,responsible forreviewing inpatient claims andensuring thatthe DRG paid is fair and accurate, based on the documentation in the medical recordandthe application of ICD-10-CM and ICD-10-PCS coding conventions, instructions, guidelines,policies,and Coding Clinic advice.TheDRGValidationAuditorupholdsthe standards ofhonesty,excellence,and innovation thatare central to the Penstockmission.
- Conductsthorough, thoughtfulreviewsofhealthcare claimsand medical recordstoidentifydiscrepancies between the physician documentation, the clinical picture depicted in the record, the codes billed, and the resulting DRG
- Appropriately uses industry-recognized references to support review findings, including the ICD-10-CM and ICD-10-PCS Official Guidelines for Coding and Reporting, AHIMA Standards of Ethical Coding, AHIMA Practice Briefs related to compliant querying, and AHA Coding Clinics
- Writes complete, clear, andaccuraterationale to supportauditdeterminations, citing specific information from the record, and referencingappropriate guidelines, policies,regulations,and/or Coding advice
- Keeps abreast ofcoding,clinical, regulatory,and other industry changes thatimpactPenstock auditing and/orthatsuggest newaudit opportunities
- Maintains focus onthe identification anddevelopment of new audit concepts
- Continuously considers the systems and processes involved with healthcarereimbursement(both internal and external) and communicates ideas for improvementthroughappropriate channels
- Participates in focused training to learn new auditing skills acrossa myriad of clinical and coding scenarios
- Communicateskindly, professionally,andeffectivelywithall customers, both internal and external,and refers issues to management as appropriate
- Continuously strives to find new avenues for fulfilling the Penstock mission of reclaiming greater integrity between payors and providers
- Serves as a Payment Integrity subject matter expert for Penstock team members and for theGoodrootorganization as a whole
- Meets or exceeds Penstocks performance and quality standards.
Qualifications and Education Requirements
- Completion and passing of the Revu Healthcare inpatient coding assessment
- Must have both payer and provider experience
- Must have clinical validation experience
- Must be able to meet for weekly meetings on Mondays at 6PM ET
- Must be able to commit to 40 hours minimum weekly
- Must hold active AHIMA coding credential(s): RHIT, RHIA, or CCS
- Must hold activeClinical Validation credential(s): CDIP, CCDS, or CDEI
- Minimum of an associatedegree
- 3or more years ofICD-10 inpatient codingexperience
- 3 or more years of clinical experience in a healthcare facility setting
- 3or more years ofauditing experience (ordemonstratedequivalent)
- Comprehensive understanding ofICD-10-CM InpatientCodingGuidelines,AHACoding Clinic, and DRG grouping mechanics
- Strong current clinical knowledgebase
- Familiarity with Clinical DocumentationIntegrity practices
- Awareness of and adherence to HIPAA, and all lawsregardingthe safeguarding of PHI/PII
- Ability toconduct independent research using credible sources
- Demonstrated working knowledgeofMicrosoft Word,Excel,and PowerPoint
- Abilityto apply critical thinkingskillsto record reviews
- Ability to work independently,manage workload,and adapt to shifting priorities
- Willingness to adapt and learn new auditing skills across a myriad ofcoding andclinical scenarios
- Excellentcommunication skills, both oral and written
- Comfortable working in an ever-changingfast pacedenvironment
- Able to work Eastern time zone hours
- Secure and private home office with reliable high-speed internet connection
Preferred Skills
- Bachelors degree in Nursing
- 5+ years of inpatient ICD-10 coding and auditing experience
- 5+years of relevant auditing(clinical validation and medical necessity) experience
- AHIMA/AAPC Coding Certification (RHIA, RHIT, CCS, CPC, CPC-H), AHIMA/ACDIS Clinical Documentation Certification (CDIP, CCDS), or Clinical Documentation Integrity experience