DRG Clinical Validation Auditor - Manila

Position Title:

Shift:

Job Description:

"Responsible for auditing inpatient medical records to ensure clinical documentation supports the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims.
•    Primary duties may include but are not limited to:
•    Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities.
•    Draws on advanced ICD-10 coding expertise, mastery of clinical guidelines, and industry knowledge to substantiate conclusions.
•    Utilizes audit tools, auditing workflow systems and reference information to generate audit determinations and formulate detailed audit findings letters.
•    Maintains accuracy and quality standards as established by audit management.
•    Identifies potential documentation and coding errors by recognizing aberrant coding and documentation patterns such as inappropriate billing for readmissions, inpatient admission status, and Hospital-Acquired Conditions (HACs).
•    Suggests and develops high quality, high value, concept and or process improvement and efficiency recommendations.
•    Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing guidelines, payer reimbursement policies, and coding terminology preferred.

Required Qualifications:
US RN - with at least two years of hospital experience
Several years of inpatient hospital coding experience
One or more of the following certification:
•    Certified Clinical Documentation Specialist (CCDS)
•    Certified Documentation Improvement Practitioner (CDIP)
•    Certified Professional Coder (CPC)
•    Inpatient Coding Credential such as CCS or CIC
No specific state licensure

Preferred Qualifications (at least 1- Bed side nursing)
•    ICU, CCU, Emergency Room, Trauma Care
•    -RHIT or RHIA (preferred Certification)"