DRG Coding​/Clinical RN Auditor

Overview

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$10,000 SIGN ON BONUS FOR EXTERNAL APPLICANTS

Optum is a global organization that delivers care, aided by technology, to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities.

Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

In this position as a Clinical DRG RN auditor
, you will apply your expert knowledge of the MS-DRG and APR-DRG coding/reimbursement methodology systems, ICD-10 Official Coding Guidelines, and AHA Coding Clinic Guidelines in the auditing of inpatient claims. You will validate ICD-10 diagnosis and procedure codes, DRG assignments, and discharge statuses billed by hospitals to identify over payments. You will compose rationales supporting your audit findings using excellent communications skills.

You will have the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.

• Conduct MS-DRG and APR-DRG coding reviews to verify the accuracy of DRG assignment and reimbursement with a focus on over payment identification
• Identify ICD-10-CM/PCS code assignment, appropriate code sequencing, POA assignment, and discharge disposition in accordance with CMS requirements, ICD-10 Official Guidelines for Coding and Reporting, and AHA Coding Clinic guidance
• Apply current ICD-10 Official Coding Guidelines and AHA Coding Clinic citations and demonstrate knowledge of clinical criteria documentation requirements used to substantiate code assignments
• Perform clinical coding review to ensure accuracy of medical coding and use clinical expertise to determine correct coding and billing
• Utilize knowledge of anatomy and physiology, diagnostic procedures, and surgical operations for ICD-10-PCS code assignment
• Write clear, accurate and concise rationales in support of findings using ICD-10 CM/PCS Official Coding Guidelines and AHA Coding Clinics
• Use proprietary workflow systems and encoder tools to make audit determinations, generate audit rationales and move claims through the workflow
• Demonstrate knowledge of and compliance with changes and updates to coding guidelines, reimbursement trends, and client processes
• Maintain and manage daily case review assignments with a focus on quality
• Provide clinical support and expertise to other investigative and analytical areas
• Work in a high-volume production environment that is matrix driven

What are the reasons to consider working for United Health Group? Competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team dedicated to your success. Some offerings include:

• Paid Time Off accrued from the first pay period plus 8 paid holidays
• Medical Plan options with Health Spending Account or Health Saving Account
• Dental, Vision, Life and AD&D Insurance, Short-term and Long-Term Disability
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
• More information at: /uhgbenefits

You'll be rewarded and recognized for your performance in an environment that will challenge you and provide development for other roles you may be interested in.

• Associate's degree (or higher)
• Unrestricted RN (Registered Nurse) license
• CCS/CIC or willingness to obtain certification within 6 months of hire
• 2+ years of MS DRG/APR DRG coding experience in a hospital environment with expert knowledge of ICD-10 Official Coding Guidelines and DRG reimbursement methodologies
• 2+ years of ICD-10-CM coding experience including principal diagnosis selection, CCs/MCCs, and SOI/ROM considerations
• 2+ years of ICD-10-PCS coding experience including body systems, root operations, body parts, approaches, devices, and qualifiers

• Experience with prior DRG concurrent and/or retrospective over payment identification audits
• Experience with Utilization Management
• Experience with readmission reviews of claims
• Experience with DRG encoder tools (e.g., 3M)
• Experience using Microsoft Excel for data tasks
• Healthcare claims experience
• Managed care experience
• Knowledge of health insurance business, industry terminology, and regulatory guidelines

• Ability to use a Windows PC and multiple applications
• Ability to work independently in a remote environment and deliver exceptional results
• Excellent written and verbal…