Conifer Health Solutions
DRG Coding Auditor - CDI Remote
Conifer Health Solutions, Frisco, Texas, United States, 75034
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CRC Coding Auditor - CDI Remote
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Conifer Health Solutions . Get AI-powered advice on this job and more exclusive features. Job Summary
The CRC Auditor conducts coding and documentation quality reviews and generates responses for cases denied by commercial and government payors. The goal is to ensure hospital inpatient, outpatient, and pro-fee claims are coded and billed according to recognized guidelines, standards, regulations, and payor requirements. Responses may include documentation of findings and formal appeal letters. The Auditor escalates trends to CRC leadership, Conifer Quality & Performance leadership, and Conifer Compliance as needed. The Auditor analyzes clinical documentation, applies evidence-based criteria, reviews physician documentation and input, and reviews medical records related to denials. They ensure appropriate actions are taken within appeal timeframes, communicate denial trends, and collaborate to improve the denial appeal process. Essential Duties and Responsibilities
Formulates and submits appeal letters using relevant clinical documentation supported by industry guidelines and standards. Reviews accounts denied for DRG validation and downgrades. Documents in denial tracking tools and maintains reports for leadership. Identifies payment methodologies, including Managed Care, Medicare, and others. Collaborates with Physician Advisors and CRC leadership on documentation concerns. Maintains expertise in healthcare trends, inpatient coding, and reimbursement methodologies. Knowledge, Skills, Abilities
Effective work prioritization and organizational skills. Compliance with safety and security policies. Critical thinking, analytical skills, and problem resolution. Ability to handle multiple tasks independently. Accuracy and proficiency in work. Excellent communication skills. Attention to detail and teamwork capability. Moderate MS Excel, PowerPoint, and Office skills. Research skills for coding and documentation issues. Ability to work remotely with minimal supervision. Education and Experience
Minimum requirements include a BSN degree or equivalent experience, RN license, and knowledge of clinical documentation and inpatient coding. Preferred candidates have CCDS certification or inpatient coding certification, along with 3-5 years of clinical RN and documentation experience, familiarity with reimbursement methodologies, and experience with appeals for clinical denials. Licenses and Certifications
Required: RN license, CCDS or related certification, or coding credentials (CCS, CCA, CIC, CPC, CPMA). Physical Demands
Ability to lift 15-30 lbs. Travel approximately 10% of the time. Sitting for extended periods at a computer. Work Environment
Typical office environment with desk, computer, and office equipment. Additional Information
Interaction with facility HIM and physician advisors. Must comply with Conifer Telecommuting policies. Compensation and Benefits
Annual salary ranges from $56,784 to $85,176, depending on location and experience. Benefits include health insurance, paid time off, 401(k), holidays, flexible spending accounts, employee assistance, and voluntary benefits. Conifer is committed to equal employment opportunity and reasonable accommodations for disabilities. #J-18808-Ljbffr
CRC Coding Auditor - CDI Remote
role at
Conifer Health Solutions . Get AI-powered advice on this job and more exclusive features. Job Summary
The CRC Auditor conducts coding and documentation quality reviews and generates responses for cases denied by commercial and government payors. The goal is to ensure hospital inpatient, outpatient, and pro-fee claims are coded and billed according to recognized guidelines, standards, regulations, and payor requirements. Responses may include documentation of findings and formal appeal letters. The Auditor escalates trends to CRC leadership, Conifer Quality & Performance leadership, and Conifer Compliance as needed. The Auditor analyzes clinical documentation, applies evidence-based criteria, reviews physician documentation and input, and reviews medical records related to denials. They ensure appropriate actions are taken within appeal timeframes, communicate denial trends, and collaborate to improve the denial appeal process. Essential Duties and Responsibilities
Formulates and submits appeal letters using relevant clinical documentation supported by industry guidelines and standards. Reviews accounts denied for DRG validation and downgrades. Documents in denial tracking tools and maintains reports for leadership. Identifies payment methodologies, including Managed Care, Medicare, and others. Collaborates with Physician Advisors and CRC leadership on documentation concerns. Maintains expertise in healthcare trends, inpatient coding, and reimbursement methodologies. Knowledge, Skills, Abilities
Effective work prioritization and organizational skills. Compliance with safety and security policies. Critical thinking, analytical skills, and problem resolution. Ability to handle multiple tasks independently. Accuracy and proficiency in work. Excellent communication skills. Attention to detail and teamwork capability. Moderate MS Excel, PowerPoint, and Office skills. Research skills for coding and documentation issues. Ability to work remotely with minimal supervision. Education and Experience
Minimum requirements include a BSN degree or equivalent experience, RN license, and knowledge of clinical documentation and inpatient coding. Preferred candidates have CCDS certification or inpatient coding certification, along with 3-5 years of clinical RN and documentation experience, familiarity with reimbursement methodologies, and experience with appeals for clinical denials. Licenses and Certifications
Required: RN license, CCDS or related certification, or coding credentials (CCS, CCA, CIC, CPC, CPMA). Physical Demands
Ability to lift 15-30 lbs. Travel approximately 10% of the time. Sitting for extended periods at a computer. Work Environment
Typical office environment with desk, computer, and office equipment. Additional Information
Interaction with facility HIM and physician advisors. Must comply with Conifer Telecommuting policies. Compensation and Benefits
Annual salary ranges from $56,784 to $85,176, depending on location and experience. Benefits include health insurance, paid time off, 401(k), holidays, flexible spending accounts, employee assistance, and voluntary benefits. Conifer is committed to equal employment opportunity and reasonable accommodations for disabilities. #J-18808-Ljbffr