Clinical Review QC Auditor

CERIS in Fort Worth, TX is seeking a DRG Quality Control/Clinical Auditor. The Diagnostic Related Groups (DRG) Clinical Auditor will be responsible for performing DRG validation (clinical/coding) reviews of medical records and/or other documentation. This role will determine correct DRG/coding as defined by review methodologies specific to the type of review. This involves completing medical record reviews, accurately documenting findings and non-findings and providing clinical/policy/regulatory support for the determination. This role will utilize their experience with ICD-10-CM & PCS coding guidelines, the ability to understand modern pharmacology, disease management and clinical intervention procedures. The ideal DRG Clinical Auditor candidate has strong written and verbal communication skills, clinical knowledge of disease processes, and knowledge of medical necessity rules. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Review medical records to determine accuracy of billing through verification of coding and review of supporting clinical documentation Check for physician's notes supporting the DRGs assigned Conduct audits to ensure accurate reimbursement and identifying potential savings Review previously conducted audits to ensure accurate coding and identifying potential savings Review all opportunities sent to the customers for complete and correct information Demonstrated knowledge of ICD-10-CM codes, PCS and DRG coding, understanding of