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/.
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