DRG Clinical Validation Nurse

At MedReview, our mission is to bring accuracy, accountability, and clinical excellence to healthcare. As such, we are a leading authority in payment integrity solutions including DRG Validation, Cost Outlier and Readmission reviews. We are seeking a registered nurse with experience in clinical validation to work within our coding department. Candidate should be highly motivated, with strong clinical and coding background. This individual must have excellent communication skills and an analytical mindset to achieve and maintain high-level performance in a fast-paced environment. This is a fulltime position (40 hours per week) Monday – Friday. You’ll enjoy the flexibility to telecommute from anywhere within the United States. Training will be conducted virtually from your home.

Perform clinical validation by ensuring diagnosis codes billed by the provider are supported within the medical record Must be able to interpret clinical guidelines/criteria and apply to clinical review Solid understanding of anatomy and physiology, diagnostic and surgical procedures developed from specialized training and extensive experience with ICD-10-PCS code assignments Demonstrates the ability to accurately interpret the medical record Writes clear, accurate and concise rationales in support of findings Maintains and manages case reviews with a high emphasis on quality Demonstrates the ability to work in a high – volume production environment Knowledge of health insurance business, industry terminology, and regulatory guidelines