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DRG Clinical Validation Nurse

MedReview

Manhattan, NY

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JOB DETAILS
JOB TYPE
Full-time
SKILLS
Analysis Skills, Anatomy, Auditing, Broadband, Case Management, Certified Coding Specialist (CCS), Clinical Nursing, Clinical Practices/Protocols, Clinical Validation, Communication Skills, Diagnosis-Related Group (DRG), HIPAA (Health Insurance Portability and Accountability Act), Health Insurance, Healthcare, ICD-10, Keyboards, LinkedIn, Medical Coding, Medical Records, Mentoring, Nursing, Patient Care, Physiology, Procedure Development, Production Systems, Production Volume, Registered Nurse (RN), Regulations, Wi-Fi, Work From Home
LOCATION
Manhattan, NY
POSTED
30+ days ago
Position Summary
At MedReview, our mission is to bring accuracy, accountability, and clinical excellence to healthcare.  As such, we are a leading authority in payment integrity solutions including DRG Validation, Cost Outlier and Readmission reviews. We are seeking a registered nurse with experience in clinical validation to work within our coding department.  
Candidate should be highly motivated, with strong clinical and coding background. This individual must have excellent communication skills and an analytical mindset to achieve and maintain high-level performance in a fast-paced environment.
This is a fulltime position (40 hours per week) Monday – Friday. You’ll enjoy the flexibility to telecommute from anywhere within the United States. Training will be conducted virtually from your home.
If you are interested in this role with MedReview, please let us know. Here is what we are searching for:

Responsibilities:
 
  • Perform clinical validation by ensuring diagnosis codes billed by the provider are supported within the medical record
  • Must be able to interpret clinical guidelines/criteria and apply to clinical review
  • Solid understanding of anatomy and physiology, diagnostic and surgical procedures developed from specialized training and extensive experience with ICD-10-PCS code assignments
  • Demonstrates the ability to accurately interpret the medical record
  • Writes clear, accurate and concise rationales in support of findings
  • Maintains and manages case reviews with a high emphasis on quality
  • Demonstrates the ability to work in a high – volume production environment
  • Knowledge of health insurance business, industry terminology, and regulatory guidelines 

Qualifications:
 
  • Minimum of two years’ experience in clinical validation in a payment integrity setting required
  • May consider nurses with inpatient claims auditing experience or case management experience.
  • Unrestricted Registered Nurse with active RN licensure required
  • CCS (Certified Coding Specialist) or CIC (Certified Inpatient Coder) certification preferred
  • CCDS or CDIP Certification preferred
  • Knowledge of ICD-10 coding
  • Basic Knowledge of DRG validation and coding
  • Ability to use Windows PC with the ability to utilize multiple applications at the same time

Remote Work Requirements
 
  • High speed internet (100 Mbps per person recommended) with secured WIFI.
  • A dedicated workspace with minimal interruptions to protect PHI and HIPAA information.
  • Must be able to sit and use a computer keyboard for extended periods of time.

Benefits and perks include:
 
  • Healthcare that fits your needs - We offer excellent medical, dental, and vision plan options that provide coverage to employees and dependents.
  • 401(k) with Employer Match - Join the team and we will invest in your future
  • Generous Paid Time Off - Accrued PTO starting day one, plus additional days off when you’re not feeling well, to observe holidays.
  • Wellness - We care about your well-being. From Commuter Benefits to FSAs, we’ve got you covered.
  • Learning & Development - Through continued education/mentorship on the job and our investment in LinkedIn Learning, we’re focused on your growth as a working professional.

Salary Rate: $85,000 – 95,000/Annually.
 

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About the Company

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MedReview