DRG​/Clinical Validation Auditor RN

About This Role

As a Clinical DRG RN Auditor at United Health Group, you will leverage your expertise in MS-DRG and APR-DRG coding methodologies to audit inpatient claims, ensuring accuracy and identifying over payments. This role is ideal for those with strong analytical skills and a commitment to improving health outcomes.

• Pay: $34.23 - $61.15 per hour
• Location:
  
  Plymouth, MN
• Schedule:
  
  Full Time, Day shift
• Sign-On Bonus: $10,000 for external applicants

• Conduct MS-DRG and APR-DRG coding reviews to verify accuracy of DRG assignment and reimbursement.
• Utilize expert knowledge to identify ICD-10-CM/PCS code assignments and appropriate code sequencing.
• Apply current ICD-10 Official Coding Guidelines and AHA Coding Clinic citations.
• Perform clinical coding reviews to ensure accuracy of medical coding.
• Write clear, accurate rationales in support of findings using coding guidelines.
• Utilize proprietary workflow systems and encoder tools to make audit determinations.
• Demonstrate knowledge of and compliance with coding guideline changes and reimbursement trends.
• Maintain and manage daily case review assignments with a focus on quality.
• Provide clinical support and expertise in investigative and analytical areas.
• Work in a high-volume production environment that is matrix driven.

• Education: Associate's Degree (or higher) required
• Experience:
  • 3+ years of MS DRG/APR DRG coding experience in a hospital environment
  • 2+ years of ICD-10-CM coding experience
  • 2+ years of ICD-10-PCS coding experience
• Licenses &
  
  Certifications:
  
  
  • Unrestricted RN (Registered Nurse) license required
  • CCS/CIC certification or willingness to obtain within 6 months of hire

• Paid Time Off plus 8 Paid Holidays
• Medical Plan options with Health Spending Account or Health Saving Account
• Dental, Vision, Life & AD&D Insurance, Short-term and Long-Term Disability coverage
• 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, etc.)

United Health Group is a leading healthcare provider committed to delivering exceptional patient care. They focus on improving health outcomes through technology and comprehensive services, ensuring that millions of people can live healthier lives. Their culture emphasizes inclusion, career development, and community impact.