Registered Nurse

This range is provided by Insight Global. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. 67/hour) with opportunity for $200-$400 bonuses weekly – Most candidates make $100-120k depending on your commitment to overtime + bonus eligibility. This role is Monday – Friday, NO WEEKENDS. 22 days of PTO with 10 paid holidaysDay to DayInsight Global is seeking a DRG Validation Auditor for one of our clients to sit 100% remote.

This person should have an extensive background in either facility-based nursing, clinical documentation, and/or inpatient coding and has a high level of understanding of reimbursement guidelines specifically an understanding of the MS-DRG, AP-DRG, and APR-DRG payment systems. This position is responsible for auditing inpatient medical records and generating high-quality recoverable claims for the benefit of our client and their clients.

They are responsible for performing clinical reviews of medical records and other documentation to evaluate issues of coding and DRG assignment accuracy. Below are the

key

responsibilities for this role:Integrates medical chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities. Draws on advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions. Performs work independently. Utilizes the clients proprietary auditing systems with a high level of proficiency to make audit determinations and generate audit letters.

Maintains production goals set by the audit operations management team. Achieves the expected level of accuracy and quality set by the audit for the auditing concept, for valid claim identification and documentation (letter writing). Identifies potential claims outside of the concept where additional recoveries may be available. Suggests and develops high-quality, high-value concepts and or process improvement, tools, etc.

Must HavesExperience working with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG with a broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, medical necessity criteria, and coding terminology.

Expert coding knowledge (DRG & ICD-10)Registered Nurse RN (must be inpatient) WITH coding/clinical documentation certification (2 years in clinical documentation)Seniority levelSeniority levelMid-Senior levelEmployment typeEmployment typeFull-timeJob functionJob functionOtherIndustriesHospitals and Health CareReferrals increase your chances of interviewing at Insight Global by 2xInferred from the description for this jobMedical insuranceVision insurance401(k)Get notified when a new job is posted.

Sign in to set job alerts for “Registered Nurse” roles. 00 8 months agoCDI Specialist, RN/BSN, CCDS (FT/REMOTE) (CDI experience req'd)We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI. #J-18808-Ljbffr. 000000.