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(Archived) RN Clinical Documentation Specialist
Last Updated: 7/11/22
Job Description
Position responsibilities:
- Conduct coding audits of submitted claims
- Create standardized audit tool for review of hospital, outpatient, and professional claims
- Develop audit reports of audit findings
- Gather and analyze information and summarizes findings and metrics pertinent to documentation of chart review investigations
- Assess medical records as applicable to ensure they substantiate services billed
- Evaluates claims billed for appropriate CPT, ICD-10, and HCPCS codes.
- Review high dollar professional and facility claims to validate charges paid to ensure documentation supports level of care billed.
- Analyze health claim history reports to identify coding as well as billing patterns
- Current active, unrestricted license as an RN in California required.
- 3 years of experience as a registered nurse with 2 years of recent experience focused on in-patient or out-patient coding, healthcare and coding regulations including code structure, clinical documentation, DRG (Diagnosis Related Group) experience, criteria-based chart reviews (ex. Utilization Management or Case Management) required.
- 1 year of Utilization Review experience is required.
Company Details
Wayne, Pennsylvania, United States
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