Quality Review & Audit Lead Analyst - DRG Coder - Remote - The Cigna Group
Bloomfield, CT
About the Job
The DRG Auditor performs an in-depth review of the medical record to evaluate the diagnostic and procedural information in the record and validates accurate coding classification for the DRG assignment for reimbursement of services rendered.
RESPONSIBILITIES:
Reviews clinical documentation and validates facility coding for APR and MS DRG assignment.
Demonstrated ability to understand the clinical content of a medical record, including the most complicated records.
Ability to communicate with Medical Directors when clinical validation is required.
Ability to summarize APR and MS DRG disputes in writing and cites official coding guidelines.
Ability to demonstrate knowledge of and utilize auditing skills related to coding quality and compliance.
Maintains and continuously improves knowledge base of coding/DRG/documentation requirements through review and study of resources and through continuing education.
Ability to serves as a resource to facilitate understanding DRG auditing.
Ability to advise supervisory staff of any concerns or complaints expressed by internal and external customers.
Ability to utilize effective communication; courtesy and professionalism in all interactions.
Performs additional unit duties below as appropriate: participate on special projects; perform random or focused review as required and interface with contracting and provider relations as appropriate to meet customer’s needs.
REQUIREMENTS:
Bachelor’s Degree or higher strongly preferred or equivalent work experience.
Certified Coding Certificate - must have experience in DRG coding using ICD-10 coding system - 3+ years required.
Certified Coding Specialist (CCS) or Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) required.
RN License preferred but not required.
Knowledge of CMS regulations and statutes.
Knowledge of state/regional insurance regulations.
Ability to deal with highly sensitive and confidential information and adhere to data security and HIPAA confidentiality procedures;
Knowledge of Inpatient coding guidelines and practices.
Effective written and verbal communication skills along with a working knowledge of Microsoft Office.
Ability to apply general rules to specific problems to produce answers that make sense.
Must be able to work independently and as a team while maintaining close attention to detail.
Must be highly motivated, have excellent prioritization skills and have the ability to set and reach goals
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
For this position, we anticipate offering an annual salary of 65,600 - 109,400 USD / yearly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group .
About Cigna Healthcare
Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.
_Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws._
_If you require reasonable accommodation in completing the online application process, please email:_ _SeeYourself@cigna.com_ _for support. Do not email_ _SeeYourself@cigna.com_ _for an update on your application or to provide your resume as you will not receive a response._
_The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State._
_Qualified applicants with criminal histories will be considered for employment in a manner_ _consistent with all federal, state and local ordinances._
RESPONSIBILITIES:
Reviews clinical documentation and validates facility coding for APR and MS DRG assignment.
Demonstrated ability to understand the clinical content of a medical record, including the most complicated records.
Ability to communicate with Medical Directors when clinical validation is required.
Ability to summarize APR and MS DRG disputes in writing and cites official coding guidelines.
Ability to demonstrate knowledge of and utilize auditing skills related to coding quality and compliance.
Maintains and continuously improves knowledge base of coding/DRG/documentation requirements through review and study of resources and through continuing education.
Ability to serves as a resource to facilitate understanding DRG auditing.
Ability to advise supervisory staff of any concerns or complaints expressed by internal and external customers.
Ability to utilize effective communication; courtesy and professionalism in all interactions.
Performs additional unit duties below as appropriate: participate on special projects; perform random or focused review as required and interface with contracting and provider relations as appropriate to meet customer’s needs.
REQUIREMENTS:
Bachelor’s Degree or higher strongly preferred or equivalent work experience.
Certified Coding Certificate - must have experience in DRG coding using ICD-10 coding system - 3+ years required.
Certified Coding Specialist (CCS) or Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) required.
RN License preferred but not required.
Knowledge of CMS regulations and statutes.
Knowledge of state/regional insurance regulations.
Ability to deal with highly sensitive and confidential information and adhere to data security and HIPAA confidentiality procedures;
Knowledge of Inpatient coding guidelines and practices.
Effective written and verbal communication skills along with a working knowledge of Microsoft Office.
Ability to apply general rules to specific problems to produce answers that make sense.
Must be able to work independently and as a team while maintaining close attention to detail.
Must be highly motivated, have excellent prioritization skills and have the ability to set and reach goals
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
For this position, we anticipate offering an annual salary of 65,600 - 109,400 USD / yearly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group .
About Cigna Healthcare
Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.
_Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws._
_If you require reasonable accommodation in completing the online application process, please email:_ _SeeYourself@cigna.com_ _for support. Do not email_ _SeeYourself@cigna.com_ _for an update on your application or to provide your resume as you will not receive a response._
_The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State._
_Qualified applicants with criminal histories will be considered for employment in a manner_ _consistent with all federal, state and local ordinances._
Source : The Cigna Group