DRG Clinical Validation Nurse

TL;DR

DRG Clinical Validation Nurse (Healthcare): Perform clinical validation of diagnosis codes billed by providers against medical records with an accent on interpreting clinical guidelines and applying them to reviews. Focus on writing clear rationales for findings, managing high-volume case reviews, and ensuring quality in a fast-paced production environment.

Location: Telecommute from anywhere within the United States

Salary: $85,000 – $95,000/Annually

Company

Leading authority in payment integrity solutions including DRG validation, cost outlier, and readmission reviews.

What you will do

• Perform clinical validation to ensure diagnosis codes are supported by the medical record
• Interpret clinical guidelines and criteria for accurate application in reviews
• Accurately interpret medical records and write clear, concise rationales for findings
• Maintain and manage case reviews with high emphasis on quality
• Work effectively in a high-volume production environment

Requirements

• Minimum of two years’ experience in clinical validation in a payment integrity setting
• Unrestricted active RN licensure required
• Solid understanding of anatomy, physiology, diagnostic and surgical procedures
• Knowledge of ICD-10 coding and basic DRG validation
• Ability to use Windows PC and multiple applications simultaneously
• High-speed internet (100 Mbps recommended), secured WiFi, dedicated workspace to protect PHI and HIPAA

Nice to have

• Inpatient claims auditing or case management experience
• CCS (Certified Coding Specialist) or CIC (Certified Inpatient Coder) certification
• CCDS or CDIP certification

Culture & Benefits

• Excellent medical, dental, and vision plans for employees and dependents
• 401(k) with employer match
• Generous PTO accrued from day one, plus sick days and holidays
• Wellness support including commuter benefits and FSAs
• Learning and development through on-the-job mentorship and LinkedIn Learning