Insight Global Hiring for Remote DRG Medical Reviewer Job at Remote Full Time

Desired Skills and Experience

– Active Coding Certification – ideally Certified Inpatient Coder (CIC)

– 3 years former inpatient coding or auditing experience

– Experience performing DRG auditing/coding validation on inpatient medical records utilizing ICD-10 and PCS guidelines on MS-DRG or APR-DRG claims.

– Able to follow job aids and client specific review guidelines for auditing/reviewing.

– NCCI/CCI edits experience

– Evaluation & management (E/M) coding experience

– Ability to work remotely from home in a home office space with a door

– Only possess this coding position, as it is against their contractual agreement with their clients for them to have another coding position outside of this position.

Soft skills

– Working knowledge of medical terminology and claim coding.

– Strong written and verbal communications skills.

– Strong customer service skills.

– Ability to work in a team.

– Proficient with personal computers

Plusses

Day-to-Day

Investigate the client’s Waste and Error stopped claims by gathering information, researching state and federal guidelines, and following internal procedures to determine the viability of the claim for further review in a production environment.

Perform clinical review of professional (or facility) claims vs. medical records to determine if the claim is supported or unsupported. Will be working with the client’s External Commercial team consisting of other certified coders.

Top Responsibilities:

– Clinical Case Reviews -75%

– Perform clinical review of professional (or facility) claims vs. medical records to determine if the claim is supported or unsupported.

– Maintain standards for productivity and accuracy. Standards are defined by the department.

– Provide clear and concise clinical logic to the providers when necessary.

– Other internal customer correspondence and team needs 15%

– Attend and provide feedback during monthly meetings with assigned internal customer department.

– Provide continuous feedback on how to improve department relationships with internal team members and departments.

– Continue education 10%

– Keep up required Coding Certificate and/or Nursing Licensure.

– Complete compliance hours as required by the department.

What software tools/skills are needed to perform these daily responsibilities? Microsoft Office Excel, Outlook, etc.

How will performance be measured? monthly audits of reviewed work with a 95% or higher accuracy rate for goal

30 minutes Teams audio interview to hire

Job Type: Full-time

Pay: $26.00 – $30.00 per hour

Benefits:

• Dental insurance
• Flexible schedule
• Health insurance
• Vision insurance
• Work from home

Schedule:

• 8 hour shift
• Monday to Friday

Application Question(s):

• Do you have expereince with NCCI/CCI edits?
• Do you have an active coding certification? Ideally CIC, CPC, COC, CPMA, or CCS
• Do you have 3 years former inpatient coding or auditing expereince?
• Do you have experince performing DRG auditing/coding validation on inpatient medical records?
• Do you have Evaluation and Management (E/M) leveling experience?

Work Location: Remote