[Remote] Clinical Review Auditor I

🌍 Remote, USA 🚀 Full-time 🕐 Posted Recently

Job Description

Note: The job is a remote job and is open to candidates in USA. CorVel Corporation is a certified Great Place to Work® Company dedicated to accuracy and transparency in healthcare payments. They are seeking a Clinical Review Auditor I responsible for performing DRG validation reviews of medical records, ensuring accurate reimbursement, and providing clinical support based on coding guidelines.

Responsibilities

The Clinical Auditor will review medical records to determine accuracy of billing through verification of coding and review of supporting clinical documentation
Conduct audits to ensure accurate reimbursement and identifying potential savings
Demonstrated knowledge of ICD-10-CM codes, PCS and DRG coding, understanding of payer rules and regulations, including Medicare and Medicaid
Understand and comply with all internal and external policies
Working knowledge of HIPAA Privacy and Security Rules
Assist Quality Control team and medical director with appeals, rebuttals, etc
Notify leadership of any issues or concerns in a timely manner
Additional duties as assigned

Skills

CCS or CIC required with DRG auditing experience in ICD-10-CM, ICD-10 PCS
Demonstrated knowledge of ICD-10-CM codes, PCS and DRG coding, understanding of payer rules and regulations, including Medicare and Medicaid
Working knowledge of HIPAA Privacy and Security Rules
Effective and professional communication skills, both verbal and written
Ability to work independently and in a team environment
High attention to detail
Must possess critical thinking skills
Ability to multi-task and assist with team coverage and provide support when needed
Ability to build relationships both internally and externally
Ability to work in a fast-paced environment
Demonstrated proficiency in basic computer skills and typing
Proficiency with Microsoft Office
LVN or RN license in the state of employment preferred
Experience in the OR, ICU, or ER as an RN highly preferred

Benefits

Medical (HDHP) w/Pharmacy
Dental
Vision
Long Term Disability
Health Savings Account
Flexible Spending Account Options
Life Insurance
Accident Insurance
Critical Illness Insurance
Pre-paid Legal Insurance
Parking and Transit FSA accounts
401K
ROTH 401K
Paid time off

Company Overview

CorVel is a nationally recognized claims management and managed care provider with over 30 years of experience in the industry. It was founded in 1987, and is headquartered in Irvine, California, USA, with a workforce of 1001-5000 employees. Its website is https://www.corvel.com/.

Apply To This Job