Clinical DRG Auditor Registered Nurse
5128 Apache Plume Rd , Suite 400 Fort Worth, TX 76109 US
Job Description
Clinical DRG Auditor Registered Nurse- Remote
Hours: Mon - Fri 8:00a.m. - 5:00p.m. cst
Salary Based on Experience
Cornerstone Medical is searching for a Registered Nurse with DRG Auditor experience. The Auditor will be responsible for accurately reviewing pre and post pay claim audits based on client, policy, industry standards and/or CMS guidelines.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:
- Reviews, analyzes, and completes internal audits and/or appeals in accordance with client policy, CMS guidelines and industry standards in clear and professional written communication.
- Ability to use clinical judgement and analytical skills to appropriately review documentation submitted for claim audits.
- Utilize clinical judgement to appropriately interpret and apply client policies along with CMS guidelines as it relates to reviews done such as itemized bill, DRG and/or specialty audits.
- Utilize applicable tools and resources to complete internal audits and/or appeals.
- Timely completion of internal audits and/or appeals.
- Attends Clinical Team Meetings, All Company Meetings, Education Opportunities, Trainings, and other potential meetings
- Additional duties as assigned.
KNOWLEDGE & SKILLS:
- Ability to demonstrate understanding of CMS and commercial payer policy in written and verbal format
- Strong understanding of claims processing, ICD-10 Coding, DRG Validation, Coordination of Benefits
- Strong understanding of healthcare revenue cycle and claims reimbursement
- Proficient in Microsoft Office including Pivot Tables and Database Management
- Comfortable interfacing with clients and the C-Suite
- Demonstrate ability to manage multiple projects, set priorities and adhere to committed schedule
- Strong interpersonal skills and adaptive communication style, complex problem solving skills, drive for results, innovative
- Excellent written and verbal communication skills
- Proven track record of delivering concrete results in strategic projects/programs
- Strong analytical and modeling ability and distilling data into actionable results
- Superb attention to detail and ability to deliver results in a fast paced and dynamic environment
EDUCATION/EXPERIENCE:
- Must maintain a current RN licensure
- Previous experience with health insurance denials and/or appeals, payer audits, or vendor audits
- Previous experience in one or more of the following areas required:
- Medical bill auditing
- Experience in the acute clinical areas of facilities in O.R., I.C.U.,C.C.U., E.R., Telemetry, MedSurg
- Knowledge of worker's compensation claims process
- Prospective, concurrent and retrospective utilization review
- Bachelor’s degree in healthcare or related field preferred
- 1+ years healthcare revenue cycle
- 1+ years of relevant experience or equivalent combination of education and work experience
- CPC Certification
- CCS/CIC certification
- 1+ years hospital bill audit
Benefits:
- 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.
Interested please quick apply online and text Tez @ 972-525-5539
#CSM
Job Requirements
Meet Your Recruiter
Tez Williams
Clinical Recruitment Manager
Tez has been with CornerStone Medical since November 2017. He has spent ten years in the healthcare industry, the last two years as a healthcare recruiter. He developed skills for recruiting, training and managing pipelines of 10-50 clinicians at a time while working for Fortune 500 companies. He also gained experience working multiple verticals within the healthcare industry such as allied health, clinical and non-clinical.
As the Clinical Recruitment Manager, his main objective is to locate talented clinicians who are amazing at what they do and match them with their dream jobs. He serves his candidates to the best of his ability, always going the extra mile to locate the best career opportunities in the marketplace. He once even brought a can of gas to a travel nurse stuck on the side of the road on the FIRST day of her assignment!
Tez graduated from Northwestern State University in Louisiana with a Bachelor of Science.