DRG Clinical Validation Auditor

2 days ago

PHLTaguig CityAlliance Global Tower th Ave Corner th St Uptown Bonifacio, Philippines Carelon Global Solutions Full time $420,000 - $840,000 per year

Position Title:

DRG Clinical Validation Auditor - Manila

Shift:

Job Description:

"Responsible for auditing inpatient medical records to ensure clinical documentation supports the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims.

•    Primary duties may include but are not limited to:

•    Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities.

•    Draws on advanced ICD-10 coding expertise, mastery of clinical guidelines, and industry knowledge to substantiate conclusions.

•    Utilizes audit tools, auditing workflow systems and reference information to generate audit determinations and formulate detailed audit findings letters.

•    Maintains accuracy and quality standards as established by audit management.

•    Identifies potential documentation and coding errors by recognizing aberrant coding and documentation patterns such as inappropriate billing for readmissions, inpatient admission status, and Hospital-Acquired Conditions (HACs).

•    Suggests and develops high quality, high value, concept and or process improvement and efficiency recommendations.

•    Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing guidelines, payer reimbursement policies, and coding terminology preferred.

Required Qualifications:
US RN - with at least two years of hospital experience
Several years of inpatient hospital coding experience
One or more of the following certification:

•    Certified Clinical Documentation Specialist (CCDS)

•    Certified Documentation Improvement Practitioner (CDIP)

•    Certified Professional Coder (CPC)

•    Inpatient Coding Credential such as CCS or CIC
No specific state licensure

Preferred Qualifications (at least 1- Bed side nursing)

•    ICU, CCU, Emergency Room, Trauma Care

•    -RHIT or RHIA (preferred Certification)"

  • DRG Clinical Validation Auditor

    4 days ago

    Iloilo City, Western Visayas, Philippines Elevance Health Full time ₱70,000 - ₱110,000 per year

    Position Title:DRG Clinical Validation Auditor - IloiloShift:Job Description:"Responsible for auditing inpatient medical records to ensure clinical documentation supports the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims.•    Primary duties may include but are not limited to:•  ...

  • DRG Nurse Auditor

    5 days ago

    Taguig, National Capital Region, Philippines Access Healthcare Full time ₱1,200,000 - ₱1,800,000 per year

    Join Access Healthcare Manila as a DRG Nurse Auditor. We are seeking talented individuals to join our team and help drive our success.Apply now and take the next step in your career today. We will provide free training on the client's medical billing software to perform this role.Tasks:Conduct initial audit reviews to validate billed diagnoses and DRG code...

  • DRG Nurse Auditor

    5 days ago

    Taguig, National Capital Region, Philippines Access Healthcare Services Manila, Inc. Full time ₱500,000 - ₱1,200,000 per year

    Join Access Healthcare Manila as aDRG Nurse Auditor. We are seeking talented individuals to join our team and help drive our success. Apply now and take the next step in your career today. We will provide free training on the client's medical billing software to perform this role.Tasks:Conduct initial audit reviews to validate billed diagnoses and DRG code...

  • Clinical Documentation Auditor

    3 weeks ago

    Taguig, Philippines MicroSourcing Full time

    Join to apply for the Clinical Documentation Auditor role at MicroSourcing . Discover your 100% YOU with MicroSourcing! Position: Clinical Documentation Auditor Location: Taguig Work setup & shift: Onsite | Night shift Why join MicroSourcing? You'll Have Competitive Rewards: Enjoy above-market compensation, healthcare coverage on day one, plus one or more...

  • Mgr Asst Perf Enhancement

    4 days ago

    PHL-Taguig City-Alliance Global Tower, th Ave, Corner th St, Uptown Bonifacio, Philippines Carelon Global Solutions Full time ₱1,200,000 - ₱2,400,000 per year

    Position Title:Mgr Asst Perf Enhancement (PHL)Shift:Job Description:Responsible for evaluating the quality of services and interactions provided by organizations within the enterprise.  Included are processes related to enrollment and billing and claims processing, as well as customer service written and verbal inquiries.  Primary duties may include, but...

  • Inpatient Coding Quality Auditor

    4 weeks ago

    Taguig, Philippines Conifer Health Solutions Full time

    Inpatient Coding Quality Auditor Conifer Health Solutions Job Description The Auditor, Coding Quality conducts Initial Coding Quality Reviews (IQRs), Monthly Coding Quality Reviews (MQRs), Focused Quality Audits, and other ad hoc coding quality audits as requested to ensure hospital inpatient, outpatient, and profee claims, ICD-10-CM/PCS, and/or CPT codes...

  • Inpatient Coding Quality Auditor

    5 days ago

    Taguig, National Capital Region, Philippines Conifer Health Solutions Full time ₱1,000,000 - ₱1,200,000 per year

    Job Description:The Auditor, Coding Quality conducts Initial Coding Quality Reviews (IQRs), Monthly Coding Quality Reviews (MQRs), Focused Quality Audits, and other ad hoc coding quality audits as requested to ensure hospital inpatient, outpatient , and profee claims, ICD-10-CM/PCS, and/or CPT codes were coded and billed in accordance with nationally...

  • Inpatient Coding Quality Auditor

    5 days ago

    Taguig, National Capital Region, Philippines Conifer Health Solutions Full time ₱700,000 - ₱1,200,000 per year

    Job Description:The Auditor, Coding Quality conducts Initial Coding Quality Reviews (IQRs), Monthly Coding Quality Reviews (MQRs), Focused Quality Audits, and other ad hoc coding quality audits as requested to ensure hospital inpatient, outpatient , and profee claims, ICD-10-CM/PCS, and/or CPT codes were coded and billed in accordance with nationally...

  • Outpatient Coding Quality Auditor

    4 days ago

    Taguig, National Capital Region, Philippines Conifer Health Solutions Full time ₱1,200,000 - ₱2,400,000 per year

    The Auditor, Coding Quality conducts Initial Coding Quality Reviews (IQRs), Monthly Coding Quality Reviews (MQRs), Focused Quality Audits, and other ad hoc coding quality audits as requested to ensure hospital inpatient, outpatient , and profee claims, ICD-10-CM/PCS, and/or CPT codes were coded and billed in accordance with nationally recognized coding...

  • Clinical Documentation Integrity Nurse

    3 weeks ago

    Taguig, Philippines MicroSourcing Full time

    Clinical Documentation Integrity Nurse - IP Location: TaguigWork setup & shift: Onsite | Night shift Why join MicroSourcing? Competitive Rewards: Above‑market compensation, healthcare coverage day one (you & at least one dependent), paid time‑off with cash conversion, group life insurance, performance bonuses. Collaborative Spirit: Contribute to a...