Duties:
Performs validation reviews of Diagnosis Related Groups (DRG), Adaptive Predictive Coding (APC), and Never Events (inexcusable outcomes in a healthcare setting) for all lines of business. Coordinates rate adjustments with claims areas. Provides monthly and quarterly reports outlining trends. Serves as a resource in resolving coding issues. Coordinates HIPAA and legal records requests for all areas of Healthcare Services and the Legal Department.
"75% Determines methodology to identify cases for validation review. Conducts validation reviews/coordinates rates adjustments with appropriate claims area. Creates monthly/quarterly reports to present to each line of business providing information on records review, outcomes, trends, and savings that directly impact medical costs and contracting rates.
"15% Manages records retrieval, release, HIPAA compliance, and all aspects of document management.
"10% Serves as expert resource on methodology and procedures for medical records and coding issues. null
Skills:
Required Training: Registered Records Administrator or Technician, OR, active, unrestricted RN licensure from the United States and in the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC), OR Certified Codi
Skills and Abilities:
"Develops methodologies
"Follows processes
"Responds to Inquiries
"Writes for Impact null
Schedule Notes:
MAX PAY RATE - ***/HR
CONTRACT TO HIRE
NON SCA
MONDAY-FRIDAY, 8AM-4:30PM
MANAGER WILL CONDUCT TWO INTERVIEWS, 1ST ROUND VIA TEAMS, 2ND ROUND WILL BE ONSITE WITH MANAGER AND CODER.
Please provide License/Certification required: a RHIT, RHIA, CIC, CPMA, or CPC should be the top search credentials (not RN or CCS).
FULLY REMOTE WORK- will accept candidates from SC or NC preferably but could expand the region if necessary. Client will provide equipment.
A typical day would be like this role: We are opening these positions due to increased volume of DRG review. We currently have 2 Medical Review Auditors on our team already. The normal day is DRG reviews and audits.
Experience: IP coding or RHIA/RHIT designation, that be in lieu of the actual experience. Inpatient is a heavily preferred criterion.