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DRG/Clinical Validation Auditor RN

$35-62.5/hr•Full-timeRemote

location_onMN 55, Plymouth, Hennepin County, Minnesota, 55446, United States

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Job Description

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

In this position as a Clinical DRG RN auditor, you will apply your expert knowledge of the MS-DRG and APR-DRG coding/reimbursement methodology systems, ICD-10 Official Coding Guidelines, and AHA Coding Clinic Guidelines in the auditing of inpatient claims. Employing both industry and Optum proprietary tools, you will validate ICD-10 diagnosis and procedure codes, DRG assignments, and discharge statuses billed by hospitals to identify overpayments. Utilizing excellent communications skills, you will compose rationales supporting your audit findings.

You’ll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.

What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success.

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

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.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Work location

Work model: Remote

MN 55, Plymouth, Hennepin County, Minnesota, 55446, United States

Plymouth, Minnesota

Open in Google Maps(45.01038, -93.45555)

Key Responsibilities

  • check_circleConduct MS-DRG and APR-DRG coding reviews to verify accuracy of DRG assignment and reimbursement
  • check_circleValidate ICD-10 diagnosis and procedure codes, DRG assignments, and discharge statuses in inpatient claims
  • check_circleIdentify overpayments and compose rationales supporting audit findings using coding guidelines
  • check_circleEnsure accuracy of medical coding and billing through clinical coding reviews
  • check_circleUtilize proprietary workflow systems and encoder tools to make audit determinations and generate rationales
  • check_circleMaintain and manage daily case review assignments with a high emphasis on quality
  • check_circleProvide clinical support and expertise to investigative and analytical areas

Requirements

  • verifiedAssociate's degree
  • verifiedUnrestricted RN (Registered Nurse) license
  • verifiedCCS/CIC certification or willing to obtain within 6 months of hire
  • verified2+ years of MS DRG/APR DRG coding experience in a hospital environment
  • verifiedExpert knowledge of ICD-10 Official Coding Guidelines and DRG reimbursement methodologies
  • verified2+ years of ICD-10-CM coding experience including expert knowledge of principal diagnosis selection, CCs, MCCs, SOI, and ROM
  • verified2+ years of ICD-10-PCS coding experience including expert knowledge of structural components such as body systems, root operations, body parts, approaches, devices, and qualifiers

Benefits & Perks

check_circlePaid Time Off with 8 Paid Holidayscheck_circleMedical Plan options with Health Spending Account or Health Saving Accountcheck_circleDental, Vision, Life & AD&D Insurancecheck_circleShort-term disability and Long-Term Disability coveragecheck_circle401(k) Savings Plancheck_circleEmployee Stock Purchase Plancheck_circleEducation Reimbursementcheck_circleEmployee Discountscheck_circleEmployee Assistance Programcheck_circleEmployee Referral Bonus Program

Skills, education and keywords

Skills: ms-drg, apr-drg, icd-10, icd-10-cm, icd-10-pcs, ccs, cic, microsoft excel, 3m.

Education: Associate's degree required.

Frequently asked questions about DRG/Clinical Validation Auditor RN at Registered Nurse

What does a DRG/Clinical Validation Auditor RN at Registered Nurse do?expand_more
In this DRG/Clinical Validation Auditor RN at Registered Nurse role, you will conduct ms-drg and apr-drg coding reviews to verify accuracy of drg assignment and reimbursement; validate icd-10 diagnosis and procedure codes, drg assignments, and discharge statuses in inpatient claims; identify overpayments and compose rationales supporting audit findings using coding guidelines; and ensure accuracy of medical coding and billing through clinical coding reviews.
What are the requirements for this DRG/Clinical Validation Auditor RN role?expand_more
To qualify for the DRG/Clinical Validation Auditor RN at Registered Nurse position, applicants should have: Associate's degree; Unrestricted RN (Registered Nurse) license; CCS/CIC certification or willing to obtain within 6 months of hire; 2+ years of MS DRG/APR DRG coding experience in a hospital environment; Expert knowledge of ICD-10 Official Coding Guidelines and DRG reimbursement methodologies; and 2+ years of ICD-10-CM coding experience including expert knowledge of principal diagnosis selection, CCs, MCCs, SOI, and ROM.
What is the salary range for DRG/Clinical Validation Auditor RN at Registered Nurse?expand_more
The advertised salary range for DRG/Clinical Validation Auditor RN at Registered Nurse is $35-62.5/hr.
Where is the DRG/Clinical Validation Auditor RN role at Registered Nurse located?expand_more
DRG/Clinical Validation Auditor RN at Registered Nurse is based in MN 55, Plymouth, Hennepin County, Minnesota, 55446, United States. This is a remote role.
Is this DRG/Clinical Validation Auditor RN job remote, hybrid, or on-site?expand_more
Registered Nurse has listed this DRG/Clinical Validation Auditor RN role as remote.
How much experience is required for this DRG/Clinical Validation Auditor RN role?expand_more
DRG/Clinical Validation Auditor RN at Registered Nurse typically requires 2+ years of relevant experience at the mid level level.
What skills do you need for the DRG/Clinical Validation Auditor RN role at Registered Nurse?expand_more
Key skills for DRG/Clinical Validation Auditor RN at Registered Nurse include ms-drg; apr-drg; icd-10; icd-10-cm; icd-10-pcs; ccs; cic; and microsoft excel.
What education is required for DRG/Clinical Validation Auditor RN at Registered Nurse?expand_more
Educational requirements for this role: Associate's degree required.
What category does the DRG/Clinical Validation Auditor RN role belong to?expand_more
DRG/Clinical Validation Auditor RN at Registered Nurse is part of the Healthcare & Nursing job category on Recrutus.