Job Posting – DRG Auditor

DRG Auditor

Amenity Consulting, LLC is recruiting for full time DRG Auditors. The DRG Auditor is responsible for 1) review of clinical documentation 2) determination of appropriateness of the billed Diagnosis Related Grouping to include validation of reported diagnosis and procedure codes, and 3) thorough written explanation of discrepancies that result in inappropriate reimbursement. Auditors are responsible for researching, interpreting, and applying Official Coding Guidelines, State and Federal Regulations, as well as client-specific policies, and provider-specific contract provisions that could affect the claim coding and reimbursement. The ideal candidate has an extensive background in inpatient facility billing and IPPS payment methodologies, including MS-DRG, AP-DRG, and APR-DRG including a solid understanding of medical claims adjudication systems, provider billing guidelines, payer reimbursement policies, medical necessity criteria, and coding terminology. Candidates must display excellent writing skills, strong initiative, be well organized, possess strong problem-solving and communication skills.  Candidates must also be able to work independently, with minimal supervision and demonstrate computer competencies in MS Office computer skills specifically Excel, Word and Outlook.

Key Responsibilities:

• Reviewing inpatient facility claims and medical records to confirm that the assigned DRG code is accurate, i.e., that diagnoses and procedures are coded at the appropriate level of specificity, that the discharge disposition and present on admission (POA) indicators are correct, and that the DRG is supported by appropriate clinical documentation.
• Drawing conclusions and making logical recommendations based on consideration of client preferences, unique circumstances, and client-specific information, e.g., contract provisions, policies, and financial thresholds.
• Supporting audit findings by researching and documenting Amenity and industry-standard rationale, e.g., UB/ICD coding guidelines, state and federal statutes, and CMS regulations.
• Providing subject matter expertise to Amenity’s clients.
• Handling sensitive and confidential information in a secure manner.
• Effectively utilizing Amenity’s case tracking tools to prioritize, execute, document, and report activities.
• Recommending process improvements to enhance communications, operational efficiency, outcome reporting and client satisfaction.
• Preparing written and verbal responses to provider disputes of audit findings.
• Meeting or exceeding Amenity’s audit-related productivity and quality standards, e.g., hit rate, identifications per hour, accuracy.
• Recommending process improvements to enhance communications, operational efficiency, outcome reporting and client satisfaction.

Job Requirements:

• 5+ years’ experience with industry-related coding credentials/certifications (CCS, CCS-P, CPC).
• Strong knowledge of inpatient coding methodologies, including IPPS (MS-DRG, AP-DRG, and APR-DRG), per-diems and carve-outs.
• Must demonstrate proficiency on ICD-10 & ICD-9-CM screening.
• Proficient in coding platforms such as 3M, TruCode, CMS and client specific encoders/pricers.
• Healthcare industry experience specifically working with claims data and auditing inpatient claims.
• Knowledge of Medicare and Medicaid regulations.
• Strong problem-solving abilities, strong written and verbal communication skills.
• Must comply with HIPAA Privacy and Security Rules and applicable CMS security requirements.
• Proficiency in the use of Microsoft Office software, i.e., Outlook, Word, Excel, PowerPoint, and Access; ability to create charts, presentations, graphs, and spreadsheets.
• Strong clinical knowledge, i.e., of anatomy and physiology.
• Strong interpersonal relationship skills.
• Ability to manage multiple priorities and deadlines.
• Ability to working remotely (with minimal direction) as part of a multi-disciplinary team.
• Ability to ramp up quickly in a fast-paced environment.
• Must be able to pass all pre-employment screens (including background/criminal checks and post-offer drug test).

Preferences:

• Experience in healthcare provider contracting.
• Experience in discharge planning.
• A working knowledge of HIPAA Privacy and Security Rules and applicable CMS security requirements.

This is a full-time remote employee position with full benefits; medical benefits, health savings flexible spending accounts, life insurance, paid holidays, paid time off and a matching 401(k) program. Amenity also provides employees with a computer and dual monitors to perform their job. Candidates will be required to comply with home office security requirements and other security measures.  Excellent salary, commensurate with experience and qualifications.

Amenity is a rapidly growing woman-owned business providing healthcare recovery audits, subject matter expertise, and consulting services to health plans, healthcare attorneys, and healthcare fraud and abuse investigators. Please visit us at www.amenityconsulting.com

Amenity is a flexible and family oriented company with a solid reputation in the healthcare consulting and program integrity industry.

EEOC Statement

Amenity has a strong commitment to equal opportunity in the workforce and believes in providing equal employment and advancement opportunities for all.  Amenity provides equal employment opportunity and treatment to qualified persons without regard to race, color, religion, sex, sexual orientation, national origin, age, any known disabilities, veterans or marital status, and genetic information. This policy statement is in compliance with Title VII of The Civil Rights Act of 1964, the Age Discrimination and Employment Act (ADEA), the Fair Labor Standards Act (FLSA) and the Genetic Information Nondiscrimination.