ProgenyHealth, LLC

Audit and analyze NICU claims for coding accuracy, compliance with coding guidelines, and reimbursement optimization while supporting process documentation and continuous improvement. | Registered Nurse with inpatient coding certification, 3+ years coding experience with ICD-9/10CM and DRG systems, strong knowledge of medical billing and regulatory compliance, and proficiency in Microsoft Office. | Description: • Audits and analyzes neonatal intensive care unit (NICU) claims according to ICD-10 coding principles and clinical guidelines • Analyze claims data to optimize reimbursement by ensuring diagnosis codes, procedure codes, and supporting documentation accurately support the service rendered • Ensure claims analysis complies with ethical coding standards, guidelines, and regulatory requirements • Perform clinical reviews of medical records and other documentation to validate issues of claims coding accuracy, medical necessity, and the appropriateness of treatment settings and services delivered • Research reimbursement regulations for claim payment compliance to support and validate audit findings • Assist with the development of claims audit process documentation, including workflow diagrams, policies and procedures, and standard operating procedures • Report to the Payment Assurance Manager and support a continuous improvement culture Requirements: • Registered Nurse required • Inpatient Coding Certification required - CCS or CIC • Experience in nursing, inpatient coding and reimbursement guidelines • Solid understanding of the MS-DRG, AP-DRG and APR-DRG payment systems • 3+ years of working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG • Broad knowledge of medical claims billing/payment systems, provider billing guidelines, payer reimbursement policies, medical necessity criteria and coding terminology • Adherence to official coding guidelines, coding clinic determinations, and CMS and other regulatory compliance guidelines and mandates • Requires expert coding knowledge - DRG, ICD-10, CPT, HCPCS codes • Excellent communication skills, both oral and written • Strong interpersonal skills that will support collaborative team work • Proficient in Microsoft Office: Word and Excel; Access – highly preferred • Ability to work independently and within a team • Critical listening, thinking, decision making and problem solving Benefits: • Paid Time Off • Paid Parental Leave • Medical, dental, vision benefits • 401K with company match • Short- and Long-Term Disability • Group Life Insurance • Tuition reimbursement • Professional development opportunities • Business Casual work environment