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Clinical Review Trainer

Company: CERIS Health
Location: Fort Worth
Posted on: May 26, 2023

Job Description:

The Diagnostic Related Groups (DRG) Clinical Audit Trainer is responsible for training new DRG validation staff on how to complete reviews of medical records and/or other documentation to determine correct DRG/coding that is clinically supported as defined by review methodologies specific to the contract for which review services are being provided. This involves completing medical review forms, accurately documenting findings and non-findings, and providing clinical/policy/regulatory support for the determination. A registered nurse with the additional DRG experience and qualifications would be highly preferred.
Job Responsibilities:

  • Trains and educates all of the DRG Clinical Auditors.
  • Clearly understands and complies with all internal and provider policies.
  • Demonstrated knowledge of, ICD-10-CM and PCS codes, and DRG coding, understanding of payer rules and regulations, including Medicare and Medicaid with the ability to work independently with minimal supervision and demonstrate initiative.
  • Responsible for collaborating with leadership to ensure the overall integrity of the quality of diagnosis and procedure codes verified by the clinical review auditors based on inpatient records and documentation received with the accompanied claim.
  • The ideal DRG clinical audit trainer candidate will possess strong oral and written communication skills, clinical knowledge of disease process, and expert knowledge of coding clinics and guidelines.
  • Creating new and update current working training materials and processes.
  • Working knowledge of HIPAA Privacy and Security Rules.
  • Ability to multi-task. Assist with team coverage and provide support when needed.
  • Ability to build relationships both internally and externally.
  • Ability to track training process and report to leadership.
  • Assist with training process improvement strategies.
  • Assists Quality Control team with Appeals, Rebuttals, etc.
  • Demonstrated proficiency in basic computer skills and typing, i.e., Microsoft Windows, Outlook, Word, PowerPoint, Internet Explorer, etc.
  • Notify manager/leadership of any issues or concerns in a timely manner.
  • Work closely with team leadership and CERIS training staff to identify any additional training needs.
  • Additional duties or assignments as delegated by CERIS leadership to satisfy business needs. Qualifications:
    • R.N. highly preferred, but not required.
    • CCS or CIC required with DRG auditing experience in ICD-10-CM, ICD-10 PCS.
    • Proficient in Medicare, CMS guidelines and ICD-10 coding guidelines.
    • Minimum of 3-5 years of inpatient/DRG auditing experience in a hospital setting and/or payer setting.
    • A minimum of 2 years of training experience dealing with clinical auditors is required.
    • Extreme attention to detail.
    • Must possess problem solving, and critical thinking skills.
    • Effective and professional communication skills, both verbal and written.
    • Ability to think and work independently, while working in an overall team environment.
    • Ability to work in a fast paced environment.
    • Proficient in Microsoft Office Suite.
      About CERiS
      CERiS, a division of CorVel Corporation, a certified Great Place to Work - Company, offers incremental value, experience, and a sincere dedication to our valued partners. Through our clinical expertise and cost containment solutions, we are committed to accuracy and transparency in healthcare payments. We are a stable and growing company with a strong, supportive culture along with plenty of career advancement opportunities. We embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).
      A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.
      CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.

Keywords: CERIS Health, Fort Worth , Clinical Review Trainer, Human Resources , Fort Worth, Texas

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