Inpatient DRG Validation Auditor

Disclaimer: This is a 1099 independent contractor position requiring a minimum commitment of 30 hours per week. The contract term is one year, with the option to renew. Role and Responsibilities ​   The   DRG Validation   Auditor   is a   valued member of   the   Penstock   Audit   team ,   responsible for   reviewin g inpatient claims and   ensuring that   the DRG paid is fair and accurate, based on the documentation in the medical record   and   the application of ICD-10-CM and ICD-10-PCS coding conventions, instructions, guidelines,   policies,   and Coding Clinic advice .   The   DRG   V alidat ion   Audito r   upholds   the standards of   honesty,   excellence ,   and innovation that   are central to the Penstock   mission .   Conducts  thorough , thoughtful  reviews  of  healthcare claims  and medical records   to  identify  discrepancies between the physician documentation, the clinical picture depicted in the record, the codes billed, and the resulting DRG   Appropriately uses industry-recognized references to support review findings, including the ICD-10-CM and ICD-10-PCS Official Guidelines for Coding and Reporting, AHIMA Standards of Ethical Coding, AHIMA Practice Briefs related to compliant querying, and AHA Coding Clinics   Writes complete, clear, and  accurate  rationale to support  audit  determination s , citing specific information from the record, and referencing  appropriate guidelines , policies,  regulations,  and/or Coding advice   Keeps abreast of   coding,  clinical, regulatory,  and other industry changes that  impact  Penstock auditing and/or  that  suggest new  audi t opportunities   Maintains focus o n  the identification and  development of new audit concepts   Continuously considers the systems and processes involved with healthcare  reimbursement  (both internal and external) and communicates ideas for improvement   through  appropriate channels   Participates in focused training to learn new auditing skills across  a myriad of clinical and coding scenarios   Communicates   kindly , professionally,  and  effectively  with  all customers , both internal and external ,  and refers issues to management as appropriate   Continuously strives to find new avenues for fulfilling the Penstock mission of reclaiming greater integrity between payors and providers    Serves as a Payment Integrity subject matter expert for Penstock team members and for the  Goodroot  organization as a whole   Meets or exceeds Penstock’s performance and quality standards.     ​ ​ Qualifications and Education Requirements ​   Completion and passing of the Revu Healthcare inpatient coding assessment Must have both payer and provider experience Must have clinical validation experience Must be able to meet for weekly meetings on Mondays at 6PM ET Must be able to commit to 40 hours minimum weekly Must hold active AHIMA coding credential(s): RHIT, RHIA, or CCS  Must hold active   Clinical Validation credential(s):  CDIP, CCDS, or CDEI  Minimum of an associate  degree   3  or more years of  IC D-10 inpatient coding  experience   3 or more years of clinical experience in a healthcare facility setting   3  or more years of  auditing experience (or  demonstrated  equivalent)   Comprehensive understanding of  ICD-10-CM I npatient  C oding  G uidelines ,  AHA  Coding Clinic , and DRG grouping mechanics   Strong current clinical knowledgebase   Familiarity with Clinical Documentation  I ntegrity practices    Awareness of and adherence to HIPAA, and all laws  regarding  the safeguarding of PHI/PII   Ability to  conduct independent research using credible sources   Demonstrated w orking knowledge  of  Microsoft Word,  Excel,  and PowerPoint   Ab ility  to apply critical thinking  skills  to record reviews   Ability to work independently ,  manage workload ,  and adapt to shifting priorities   Willingness to adapt and learn new auditing skills across a myriad of  coding and  clinical scenarios   Excellent  communication skills, both oral and written   Comfortable working in an ever-changing  fast paced  environment   Able to work Eastern time zone hours    Secure and private home office with reliable high-speed internet connection   ​ ​ Preferred Skills ​   Bachelor’s degree in Nursing 5 + years of inpatient ICD-10 coding and auditing experience   5+  years of relevant auditing  (clinical validation and medical necessity) experience   AHIMA/AAPC Coding Certification (RHIA, RHIT, CCS, CPC, CPC-H), AHIMA/ACDIS Clinical Documentation Certification (CDIP, CCDS), or Clinical Documentation Integrity experience