DRG Validator

Company Overview

RevCycle Xperts, Inc. (RCX)
RCX is a leader in revenue cycle integrity auditing, specializing in DRG and Clinical validation services for both Providers and Payors in the healthcare industry. Our progressive business model offers unmatched flexibility and the opportunity to work with cutting-edge tools and professionals across the U.S.

Job Summary

RevCycle Xperts, Inc. (RCX) is looking for certified, credentialed and experienced ICD-10-CM/DRG Reviewers with 4 to 5 years of experience. Join our leading team in DRG and Clinical validation services. We specialize in revenue cycle integrity auditing on both Provider and Payor sides of healthcare delivery.

Our business model is one of the most progressive in the nation. RCX, a leading provider of DRG and Clinical validation services, offers unique opportunities for you to have the flexibility in scheduling your own hours as long as you meet the minimum 20 hours per week requirement. All work is remote!!

So, join RevCycle Xperts (RCX) in providing cutting edge revenue cycle integrity auditing serving both Providers and Payors.

If you have RHIA, RHIT, CCS and CDI/ CCDS (with CCS) and 4+ years of auditing experience, please send your resume.

Responsibilities

• Perform comprehensive inpatient DRG validation reviews to determine accuracy of the DRG billed, based on industry standard ICD 10 coding guidelines and the clinical evidence supplied by the provider in the form of medical records.
• Based on the evidence presented in the medical records, determine, and record the appropriate (revised) Diagnosis Codes, Procedure Codes and Discharge Status Code applicable to the claim.
• Utilize proprietary workflow systems and encoder tools to efficiently and accurately make audit determinations, generate audit rationales.
• Meet or exceed established project productivity and quality goals by moving claims through the workflow process appropriately.

Qualifications

Expert inpatient coding skills with superior knowledge of regulatory ICD-10-CM / PCS coding, Official Guidelines for Coding and Reporting and Coding Clinic Guidance coupled with MS-DRG and APR-DRG payment methodologies with one or more of the following credentials preferred:

• CCS or CIC
• RHIA or RHIT
• Thorough understanding of the revenue cycle and the various DRG Groupers necessary for case assignments & payor-specific billing/reimbursement.
• 3+ years reviewing and/or auditing ICD-10 CM, MS-DRG and APR-DRG claims preferred.
• Able to work a minimum of 20 hours per week-flexible hours.‍

Preferred Skills

• Proficiency in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint) and Google applications; prefers knowledge in the use of intranet and internet applications.
• Prefer candidate with prior DRG retrospective overpayment identification auditing experience.
• Experience working in a remote environment.
• Excellent communication skills written and verbal.

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Additional Notes

This position is for Payer/Insurance claim reviews. May include resolution expertise in complex review cases.

• Job Types: Full-time, Part-time, Contract
• Expected hours: No less than 20 per week
• Benefits: Flexible schedule
• Experience: DRG: 3 years (Required)
• Work Location: Remote