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Clinical/DRG validation Specialist
3 months ago
Qualifications:
Minimum of 2-4 years of experience in Clinical Validations and at least 5 years in Inpatient Facility coding
Education:
Life Sciences Graduate or Postgraduate
Credentials:
Must possess active AHIMA/AAPC certification(s)
Communication:
Outstanding verbal and written proficiency in English
Work Location:
Must be ready to work from the Hyderabad office
Responsibilities:
Ability to appeal clinically denied diagnoses using clinical and coding guidelines without missing due dates.
Involvement in the clinical denial/appeal process for DRG challenges and clinical validations through Clinical Validation Audits.
Reviewing payer denials, determining if an appeal is justified, and writing appeals.
Ensuring accurate code assignment by thoroughly understanding coding conventions, guidelines, and updates.
Experience in reading and comprehending medical records.
Conducting clinical validation by reviewing physician documentation to ensure correct codes and sequencing are applied to claims.
Accurately depicting the clinical scenario within the constructs of the ICD-10-CM/PCS code set.
Understanding and validating the appropriateness of services rendered, ensuring that documented conditions meet reportable claims data requirements.