healthcare
Posted Mar 17Inpatient Claims Auditor | Medical Coding [remote]
at Machinify
United StatesRemote
Responsibilities
- Audit patient medical records using clinical, coding, and payer guidelines to ensure accurate reimbursement.
- Collaborate with team leaders to ensure thorough review of DRG denials.
- Conduct audits in alignment with organizational quality and timeliness standards.
- Recommend improvements to the audit system to enhance efficiency.
- Ensure compliance with HIPAA regulations for protected health information.
- Perform other duties as assigned.
Requirements
- Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise.
- This position requires an in-depth understanding of clinical guidelines, coding protocols, and regulatory
- An associate or bachelor’s degree in nursing (active/unrestricted license); or in health information management is required. Work
- Certification (at least one of the following is required):
- CCDS - Certified Clinical Documentation Specialist
- CIC - Certified Inpatient Coder
- experience of 2 years or more required, and/or Inpatient Clinical Documentation Integrity
- experience of 2 years or more required
- Proven ability to apply critical judgment in clinical and coding determinations.
- In-depth knowledge of clinical criteria and documentation
- Expert in DRG methodologies (e.g., MS & APR).
- Expertise in ICD-10-CM/PCS coding, UHDDS definitions, Official Coding Guidelines, and AHA’s Coding Clinic Guidelines.
- Ability to work independently and efficiently with minimal supervision.
Benefits
- We’re constantly reimagining what’s possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.
- Top Medical/Dental/Vision offerings FSA/HSA