Description:

The Clinical Auditor will look at individual medical records to check for missing documentation;

The Clinical Auditor will check for physician's notes supporting the DRGs assigned.

Reviewing medical records to determine accuracy of billing through verification of coding and supporting clinical documentation.

Conducting audits to ensure accurate charge capture, enhancing reimbursement and identifying potential savings.

Demonstrated knowledge of CPT, ICD-10 codes, HCPCs and DRGs coding, understanding of payer rules and regulations, including Medicare and Medicaid with the ability to work independently with minimal supervision and demonstrate initiative.

Able to clearly and accurately communicate findings

Qualifications:

RN licensed with a required a minimum of 1 year of recent clinical auditing experience in a hospital setting, or health plan. National Coding Certification required through AHIMA (preferred) or AAPC.

Extensive hands-on ICD-10 CM / PCS experience required.

Proficient in both MS and APR DRG methodology.

Working knowledge of application of current Official Coding Guidelines and Coding Clinic citations

Solid knowledge and understanding of clinical criteria documentation requirements used to successfully substantiate code assignments.

Proficient in Medicare and CMS guidelines

Extreme attention to detail.

Must possess problem solving, critical thinking skills.

Minimal typing experience.

Effective and professional communication skills, both verbal and written.

Ability to think and work independently, while working in an overall team environment.

Ability to work in a fast paced/production environment.

Proficient in Microsoft Office Suite.

Other duties as assigned

Skills:

ICD-10, AHIMA, AAPC, Nurse, Coding, RN, Medicare, RHIT

Experience Level:

Intermediate Level

About Actalent:

Actalent connects passion with purpose. Our scalable talent solutions and services capabilities drive value and results and provide the expertise to help our customers achieve more. Every day, our experts around the globe are making an impact. We’re supporting critical initiatives in engineering and sciences that advance how companies serve the world. Actalent promotes consultant care and engagement through experiences that enable continuous development. Our people are the difference. Actalent is an operating company of Allegis Group, the global leader in talent solutions.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.