Drg Validation Auditor

h3Role and Responsibilities /h3 pNon è sicuro/a delle competenze necessarie per questa opportunità? Legga la descrizione completa qui sotto per avere un quadro completo dei requisiti richiesti. /p pThe DRG Validation Auditor is a valued member of the Penstock Audit team, responsible for reviewing inpatient claims and ensuring that the DRG paid is fair and accurate, based on the documentation in the medical record and the application of ICD-10-CM and ICD-10-PCS coding conventions, instructions, guidelines, policies, and Coding Clinic advice. The DRG Validation Auditor upholds the standards of honesty, excellence, and innovation that are central to the Penstock mission. /p ul liConducts thorough, thoughtful reviews of healthcare claims and medical records to identify discrepancies between the physician documentation, the clinical picture depicted in the record, the codes billed, and the resulting DRG /li liAppropriately uses industry-recognized references to support review findings, including the ICD-10-CM and ICD-10-PCS Official Guidelines for Coding and Reporting, AHIMA Standards of Ethical Coding, AHIMA Practice Briefs related to compliant querying, and AHA Coding Clinics /li liWrites complete, clear, and accurate rationale to support audit determinations, citing specific information from the record, and referencing appropriate guidelines, policies, regulations, and/or Coding advice /li liKeeps abreast of coding, clinical, regulatory, and other industry changes that impact Penstock auditing and/or that suggest new audit opportunities /li liMaintains focus on the identification and development of new audit concepts /li liContinuously considers the systems and processes involved with healthcare reimbursement (both internal and external) and communicates ideas for improvement through appropriate channels /li liParticipates in focused training to learn new auditing skills across a myriad of clinical and coding scenarios /li liCommunicates kindly, professionally, and effectively with all customers, both internal and external, and refers issues to management as appropriate /li liContinuously strives to find new avenues for fulfilling the Penstock mission of reclaiming greater integrity between payors and providers /li liServes as a Payment Integrity subject matter expert for Penstock team members and for the Goodroot organization as a whole /li liMeets or exceeds Penstock’s performance and quality standards. /li liSenior Auditor positions provide support for Team Lead as required. /li /ul pPenstock is a service partner and SaaS builder for forward-thinking health plans and providers, empowering recovery, audit, and regulatory teams to get accuracy right from the start—when it matters most. Our mission is to create lasting systemic change that removes wasted spend from our healthcare system, returning dollars to payers, lowering the cost of care, and improving access for all. Our business model is rooted in transparency and the drive to reinstate true integrity in payment integrity—even if it defies traditional business sense. We geek out over building and perfecting software that helps health plans succeed, but we also understand the irreplaceable value of human intelligence. /p h3Qualifications and Education Requirements /h3 ul liMinimum of an associate degree /li liCurrent AHIMA Health Information Management credential(s): RHIT or RHIA /li liCurrent AHIMA/AAPC Coding Credential: CCS or CIC /li liCurrent Clinical Validation credential(s): CDIP, CCDS, or CDEI /li li3 or more years of ICD-10 inpatient coding experience /li li1 or more years of clinical experience in a healthcare facility setting /li li3 or more years of auditing experience (or demonstrated equivalent) /li li1 or more years of auditing experience in a payor setting /li li1 or more years of experience in Inpatient Rehabilitation coding/auditing /li li1 or more years of experience in Inpatient Psychiatric coding/auditing /li liComprehensive understanding of ICD-10-CM Inpatient Coding Guidelines, AHA Coding Clinic, and DRG grouping mechanics /li liStrong current clinical knowledgebase /li liFamiliarity with Clinical Documentation Integrity practices /li liAwareness of and adherence to HIPAA, and all laws regarding the safeguarding of PHI/PII /li liAbility to conduct independent research using credible sources /li liDemonstrated working knowledge of Microsoft Word, Excel, and PowerPoint /li liAbility to apply critical thinking skills to record reviews /li liAbility to work independently, manage workload, and adapt to shifting priorities /li liWillingness to adapt and learn new auditing skills across a myriad of coding and clinical scenarios /li liExcellent communication skills, both oral and written /li liComfortable working in an ever-changing fast paced environment /li liAble to work Eastern time zone hours /li liSecure and private home office with reliable high-speed internet connection /li /ul h3Preferred Skills /h3 ul liBachelor’s degree /li liAH