University of Minnesota School of Nursing
DRG/CVA Validation Auditor RN
University of Minnesota School of Nursing, Minneapolis, Minnesota, United States, 55400
Sign‑On Bonus
$10,000 SIGN ON BONUS FOR EXTERNAL APPLICANTS.
Company Overview Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities.
Job Title DRG/CVA Validation Auditor RN
Primary Responsibilities
Conduct MS-DRG and APR-DRG coding reviews to verify the accuracy of DRG assignment and reimbursement with a focus on overpayment identification.
Utilize expert knowledge to identify the ICD-10-CM/PCS code assignment, appropriate code sequencing, present on admission (POA) assignment, and discharge disposition, in accordance with CMS requirements, ICD-10 Official Guidelines for Coding and Reporting, and AHA Coding Clinic guidance.
Apply current ICD-10 Official Coding Guidelines and AHA Coding Clinic citations and demonstrate working knowledge of clinical criteria documentation requirements used to successfully substantiate code assignments.
Perform clinical coding review to ensure accuracy of medical coding and utilize clinical expertise and judgment to determine correct coding and billing.
Utilize solid command of anatomy and physiology, diagnostic procedures, and surgical operations developed from specialized training and extensive experience with ICD-10-PCS code assignment.
Write clear, accurate and concise rationales in support of findings using ICD-10 CM/PCS Official Coding Guidelines, and AHA Coding Clinics.
Utilize proprietary workflow systems and encoder tool efficiently and accurately to make audit determinations, generate audit rationales and move claims through workflow process correctly.
Demonstrate knowledge of and compliance with changes and updates to coding guidelines, reimbursement trends, and client processes and requirements.
Maintain and manage daily case review assignments, with a high emphasis on quality.
Provide clinical support and expertise to the other investigative and analytical areas.
Work in a high-volume production environment that is matrix driven.
Benefits
Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays.
Medical Plan options along with participation in a Health Spending Account or a Health Saving account.
Dental, Vision, Life & AD&D Insurance along with Short-term disability and Long-Term Disability coverage.
401(k) Savings Plan, Employee Stock Purchase Plan.
Education Reimbursement.
Employee Discounts.
Employee Assistance Program.
Employee Referral Bonus Program.
Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.).
More information can be downloaded at: http://uhg.hr/uhgbenefits.
Required Qualifications
Associate's degree (or higher).
Unrestricted RN (Registered Nurse) license.
CCS/CIC or willingness to obtain certification within 6 months of hire.
3+ years of MS DRG/APR DRG coding experience in a hospital environment with expert knowledge of ICD-10 Official Coding Guidelines and DRG reimbursement methodologies.
2+ years of ICD-10-CM coding experience including but not limited to expert knowledge of principal diagnosis selection, complications/comorbidities (CCs) and major complications/comorbidities (MCCs), and conditions that impact severity of illness (SOI) and risk of mortality (ROM).
2+ years of ICD-10-PCS coding experience including but not limited to expert knowledge of the structural components of PCS such as selection of appropriate body systems, root operations, body parts, approaches, devices, and qualifiers.
Preferred Qualifications
Experience with prior DRG concurrent and/or retrospective overpayment identification audits.
Experience with readmission reviews of claims.
Experience with DRG encoder tools (ex. 3M).
Experience using Microsoft Excel with the ability to create/edit spreadsheets, use sort/filter function, and perform data entry.
Healthcare claims experience.
Managed care experience.
Knowledge of health insurance business, industry terminology, and regulatory guidelines.
Soft Skills
Ability to use a Windows PC with the ability to utilize multiple applications at the same time.
Demonstrate excellent written and verbal communication skills, solid analytical skills, and attention to detail.
Ability to work independently in a remote environment and deliver exceptional results.
Excellent time management and work prioritization skills.
Physical Requirements and Work Environment
Frequent speaking, listening using a headset, sitting, use of hands/fingers across keyboard or mouse, handling other objects, long periods working at a computer.
Have a secluded office area in which to perform job duties during the work day.
Have reliable high‑speed internet access and a work environment free from distractions.
Telecommuter Policy All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.
Sign‑On Bonus Note The sign‑on bonus is only available to external candidates. Candidates who are currently working for UnitedHealth Group, UnitedHealthcare or a related entity in a full‑time, part‑time or per diem basis ("Internal Candidates") are not eligible to receive a sign‑on bonus.
Compensation Hourly pay for this role will range from $34.23 to $61.15 per hour based on full‑time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc.
EEO Statement UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
Drug‑Free Workplace Candidates are required to pass a drug test before beginning employment.
Job Application Deadline This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
#J-18808-Ljbffr
Company Overview Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities.
Job Title DRG/CVA Validation Auditor RN
Primary Responsibilities
Conduct MS-DRG and APR-DRG coding reviews to verify the accuracy of DRG assignment and reimbursement with a focus on overpayment identification.
Utilize expert knowledge to identify the ICD-10-CM/PCS code assignment, appropriate code sequencing, present on admission (POA) assignment, and discharge disposition, in accordance with CMS requirements, ICD-10 Official Guidelines for Coding and Reporting, and AHA Coding Clinic guidance.
Apply current ICD-10 Official Coding Guidelines and AHA Coding Clinic citations and demonstrate working knowledge of clinical criteria documentation requirements used to successfully substantiate code assignments.
Perform clinical coding review to ensure accuracy of medical coding and utilize clinical expertise and judgment to determine correct coding and billing.
Utilize solid command of anatomy and physiology, diagnostic procedures, and surgical operations developed from specialized training and extensive experience with ICD-10-PCS code assignment.
Write clear, accurate and concise rationales in support of findings using ICD-10 CM/PCS Official Coding Guidelines, and AHA Coding Clinics.
Utilize proprietary workflow systems and encoder tool efficiently and accurately to make audit determinations, generate audit rationales and move claims through workflow process correctly.
Demonstrate knowledge of and compliance with changes and updates to coding guidelines, reimbursement trends, and client processes and requirements.
Maintain and manage daily case review assignments, with a high emphasis on quality.
Provide clinical support and expertise to the other investigative and analytical areas.
Work in a high-volume production environment that is matrix driven.
Benefits
Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays.
Medical Plan options along with participation in a Health Spending Account or a Health Saving account.
Dental, Vision, Life & AD&D Insurance along with Short-term disability and Long-Term Disability coverage.
401(k) Savings Plan, Employee Stock Purchase Plan.
Education Reimbursement.
Employee Discounts.
Employee Assistance Program.
Employee Referral Bonus Program.
Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.).
More information can be downloaded at: http://uhg.hr/uhgbenefits.
Required Qualifications
Associate's degree (or higher).
Unrestricted RN (Registered Nurse) license.
CCS/CIC or willingness to obtain certification within 6 months of hire.
3+ years of MS DRG/APR DRG coding experience in a hospital environment with expert knowledge of ICD-10 Official Coding Guidelines and DRG reimbursement methodologies.
2+ years of ICD-10-CM coding experience including but not limited to expert knowledge of principal diagnosis selection, complications/comorbidities (CCs) and major complications/comorbidities (MCCs), and conditions that impact severity of illness (SOI) and risk of mortality (ROM).
2+ years of ICD-10-PCS coding experience including but not limited to expert knowledge of the structural components of PCS such as selection of appropriate body systems, root operations, body parts, approaches, devices, and qualifiers.
Preferred Qualifications
Experience with prior DRG concurrent and/or retrospective overpayment identification audits.
Experience with readmission reviews of claims.
Experience with DRG encoder tools (ex. 3M).
Experience using Microsoft Excel with the ability to create/edit spreadsheets, use sort/filter function, and perform data entry.
Healthcare claims experience.
Managed care experience.
Knowledge of health insurance business, industry terminology, and regulatory guidelines.
Soft Skills
Ability to use a Windows PC with the ability to utilize multiple applications at the same time.
Demonstrate excellent written and verbal communication skills, solid analytical skills, and attention to detail.
Ability to work independently in a remote environment and deliver exceptional results.
Excellent time management and work prioritization skills.
Physical Requirements and Work Environment
Frequent speaking, listening using a headset, sitting, use of hands/fingers across keyboard or mouse, handling other objects, long periods working at a computer.
Have a secluded office area in which to perform job duties during the work day.
Have reliable high‑speed internet access and a work environment free from distractions.
Telecommuter Policy All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.
Sign‑On Bonus Note The sign‑on bonus is only available to external candidates. Candidates who are currently working for UnitedHealth Group, UnitedHealthcare or a related entity in a full‑time, part‑time or per diem basis ("Internal Candidates") are not eligible to receive a sign‑on bonus.
Compensation Hourly pay for this role will range from $34.23 to $61.15 per hour based on full‑time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc.
EEO Statement UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
Drug‑Free Workplace Candidates are required to pass a drug test before beginning employment.
Job Application Deadline This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
#J-18808-Ljbffr