Nurse Coder - DRG Auditor

April 2

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Trend Health Partners

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Trend Health Partners is a healthcare technology company focused on enhancing payer-provider collaboration to improve financial management in healthcare. By leveraging AI-enabled technology, Trend Health Partners offers solutions to reduce credit balances, minimize payment denials, and ensure payment accuracy, ultimately fostering better relationships among stakeholders in the healthcare ecosystem. With a commitment to neutrality and efficiency, they aim to reshape the healthcare financial landscape for the benefit of providers, payers, and patients alike.

Technology • Claim Reimbursement • Financial Transactions • Artificial Intelligence • Business Process Improvement

201 - 500 employees

Founded 2018

⚕️ Healthcare Insurance

💳 Fintech

🤖 Artificial Intelligence

💰 Private Equity Round on 2023-01

📋 Description

• Review medical records and associated claim information to validate accuracy of DRG assignments and/or medical necessity for inpatient level of care. • Apply coding and clinical principles based on industry standards and company/client guidelines. • 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, claim selection criteria, and itemized bill review as needed. • Maintain licensures, certifications and continuing education requirements. • May require client communication to support findings.

🎯 Requirements

• An active RN professional license in good standing • 5 years of clinical practice • Coding certification in good standing (Examples: CCS, CPC, CIC) • 2-5 years 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 • 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

🏖️ Benefits

• Competitive salaries • Highly valued health insurance • 401(k) plan with employer match • Paid parental leave • And more.