[Hiring] Nurse Coder DRG Auditor III @Trend Health Partners

Role Description

The Nurse Coder DRG Auditor III’s primary responsibility is to operate as a Subject Matter Expert.

• Independently audit outpatient and inpatient claims applying coding guidelines while reviewing supporting medical documentation, completing appeal responses and communicating findings.
• Independently validate and perform quality checks for other team members.
• Execute strategic decision-making authority, and support management with enterprise-level recommendations.

Role and Responsibilities

• Utilize coding guidelines and clinical guidelines to perform DRG or APC validation.
• Validate principal diagnosis, secondary diagnoses, sequencing of diagnoses, discharge statuses and procedures utilizing the medical record.
• Evaluate short stay claims for medical necessity of an inpatient level of care.
• Apply CPT and ICD-10 guidelines.
• Apply policies, procedures, guidelines and regulations developed by Centers for Medicare and Medicaid Services (CMS), commercial payers, InterQual, MCG, and Trend Health Partners.
• Provide appeal responses for claims of the above types utilizing industry standards and company/client policies.
• Assist with new concept development.
• Assist with claim selection criteria.
• Assist with itemized bill review as needed.
• Maintain licensures, certifications and continuing education requirements.
• May require client communication to support findings.
• Independently apply and establish guidelines for others to apply coding guidelines.
• Perform quality checks for other team members.

Qualifications

• An active RN professional license in good standing.
• Clinical practice experience.
• Coding certification in good standing. Examples: CCS, CIC.
• Coding validation/auditing experience.
• Well-developed verbal and written communication skills coupled with recognizable organization.
• Ability to effectively prioritize tasks.
• Microsoft Office experience, specifically Excel.

Requirements

• Appeals experience a plus.
• APR-DRG experience a plus.
• Client communication experience a plus.
• Concept development experience a plus.
• Claim selection experience a plus.
• Experience with machine learning/artificial intelligence a plus.
• Case Management and/or Utilization Review experience a plus.
• Clinical Documentation Improvement experience a plus.
• Itemized bill validation experience a plus.
• Quality Assurance experience a plus.
• Management experience a plus.
• Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) a plus.
• TruCode/TruBridge, 3M, WebStrat or similar experience a plus.

Mental and Physical Demands

• This position will be exposed mainly to an indoor office environment and will be expected to work in or around computers and printers.
• The nature of the work is sedentary, and the employee will be sitting most of the time.
• Essential physical functions of the job include typing and the repetitive motion to utilize computer software and hardware continuously throughout the day.
• Essential mental functions of this position include concentrating on analytical tasks, reading information, and verbal/written communication to others continuously throughout the day.

Salary

$97,000 - $117,000 a year

AI Tools in Hiring Process

We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.