[Remote] Clinical Review Auditor I

Note: The job is a remote job and is open to candidates in USA. CorVel Corporation is a certified Great Place to Work® Company dedicated to accuracy and transparency in healthcare payments. They are seeking a Clinical Review Auditor I responsible for performing DRG validation reviews of medical records, ensuring accurate reimbursement, and providing clinical support based on coding guidelines.ResponsibilitiesThe Clinical Auditor will review medical records to determine accuracy of billing through verification of coding and review of supporting clinical documentationConduct audits to ensure accurate reimbursement and identifying potential savingsDemonstrated knowledge of ICD-10-CM codes, PCS and DRG coding, understanding of payer rules and regulations, including Medicare and MedicaidUnderstand and comply with all internal and external policiesWorking knowledge of HIPAA Privacy and Security RulesAssist Quality Control team and medical director with appeals, rebuttals, etcNotify leadership of any issues or concerns in a timely mannerAdditional duties as assignedSkillsCCS or CIC required with DRG auditing experience in ICD-10-CM, ICD-10 PCSDemonstrated knowledge of ICD-10-CM codes, PCS and DRG coding, understanding of payer rules and regulations, including Medicare and MedicaidWorking knowledge of HIPAA Privacy and Security RulesEffective and professional communication skills, both verbal and writtenAbility to work independently and in a team environmentHigh attention to detailMust possess critical thinking skillsAbility to multi-task and assist with team coverage and provide support when neededAbility to build relationships both internally and externallyAbility to work in a fast-paced environmentDemonstrated proficiency in basic computer skills and typingProficiency with Microsoft OfficeLVN or RN license in the state of employment preferredExperience in the OR, ICU, or ER as an RN highly preferredBenefitsMedical (HDHP) w/PharmacyDentalVisionLong Term DisabilityHealth Savings AccountFlexible Spending Account OptionsLife InsuranceAccident InsuranceCritical Illness InsurancePre-paid Legal InsuranceParking and Transit FSA accounts401KROTH 401KPaid time offCompany OverviewCorVel is a nationally recognized claims management and managed care provider with over 30 years of experience in the industry. It was founded in 1987, and is headquartered in Irvine, California, USA, with a workforce of 1001-5000 employees. Its website is https://www.corvel.com/.



Apply To This Job