DRG Auditor
Company | Waystar |
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Location | Atlanta, GA, USA |
Salary | $Not Provided – $Not Provided |
Type | Full-Time |
Degrees | |
Experience Level | Mid Level, Senior |
Requirements
- Self-sufficient with strong analytical and research skills
- In depth knowledge related to coding hospital inpatient record types, clinical documentation, payer reimbursement methodology, medical necessity criteria, billing requirements and applicable industry based standards
- Remain current on ICD and CPT/ HCPC coding requirements
- Proficient with Microsoft Office products and possess the ability to work effectively with computerized programs and databases
- Ability to communicate effectively
- Demonstrate independent judgment, discretion, and decision making abilities
- Self-motivated, hardworking individual with a high attention to detail
- Excellent organization skills
Responsibilities
- Achieve and maintain assigned client financial performance goals
- Validate code and DRG assignment and supporting clinical documentation based on physician documentation, UHDDS guidelines and official coding guidelines using proprietary technology and medical records
- Assist in prediction enhancements to increase verification rates
Preferred Qualifications
- 3+ years of inpatient auditing/coding experience with ICD and CPT/HCPCS
- Experience working within the hospital environment preferred
- Experience in MS-DRG validation, APR-DRG validation and clinical validation
- Experience related to PSI, HAC, and other quality metrics is a plus
- CCS, CPC, RHIT, RHIA, CDIP, CCDS or other coding/clinical certifications, credentials, or expertise preferred