Clinical Review QC Auditor
$68,566–$104,841 year
Remote · Fort Worth, Texas, United States or New York City, New York, United States
Job Summary
The DRG Quality Control/Clinical Auditor will perform DRG validation reviews of medical records, documenting findings and providing clinical support for coding determinations. Key responsibilities include reviewing medical records for coding accuracy, conducting audits, ensuring compliance with Medicare and Medicaid regulations, and assisting with appeals. Candidates should have ICD-10-CM & PCS coding experience, strong communication skills, and critical thinking abilities.
Required Qualifications
- National Coding Certification through AHIMA or AAPC
- Minimum 2 years of recent DRG Quality Auditing experience in a hospital setting or health plan
- Extensive hands-on ICD-10 CM / PCS experience
- LVN or RN license in the state of employment preferred
Desired Qualifications
- Knowledge of medical necessity rules
- Experience in OR, ICU, or ER as an RN
- Proficient in both MS and APR DRG methodology
Additional Requirements
- Equal Opportunity Employer, drug free workplace
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