DRG Validation Auditor at Penstock Grp.
United States
$85k - $95k
<h1 style="margin: 6pt 0in; font-size: 11pt; font-family: Calibri, sans-serif; font-variant: small-caps;"><span style="font-family: arial, helvetica, sans-serif; font-size: 10pt;"><span style="font-variant: normal !important;">Penstock </span><span style="font-weight: normal; font-variant: normal !important;">is a service partner and SaaS builder for forward-thinking health plans and providers, empowering recovery, audit, and regulatory teams to get accuracy right from the start—when it matters most. Our mission is to create lasting systemic change that removes wasted spend from our healthcare system, returning dollars to payers, lowering the cost of care, and improving access for all. Our business model is rooted in transparency and the drive to reinstate true integrity in payment integrity—even if it defies traditional business sense. We geek out over building and perfecting software that helps health plans succeed, but we also understand the irreplaceable value of human intelligence.</span></span></h1> <h1 style="margin: 6pt 0in; font-size: 11pt; font-family: Calibri, sans-serif; font-variant: small-caps;"> </h1> <p><strong><span style="font-size: 10pt; font-family: arial, helvetica, sans-serif;">Role and Responsibilities</span></strong></p> <h1 style="margin: 6pt 0in; font-size: 11pt; font-family: Calibri, sans-serif; font-variant: small-caps;"><span style="font-size: 10pt; font-weight: normal; font-variant: normal !important; font-family: arial, helvetica, sans-serif;">The DRG Validation Auditor is a valued member of the Penstock Audit team, responsible for reviewing inpatient claims and ensuring that the DRG paid is fair and accurate, based on the documentation in the medical record and the application of ICD-10-CM and ICD-10-PCS coding conventions, instructions, guidelines, policies, and Coding Clinic advice. The DRG Validation Auditor upholds the standards of honesty, excellence, and innovation that are central to the Penstock mission.</span></h1> <ul style="margin-bottom: 0in; margin-top: 2px;" type="disc"> <li style="color: black; background: white; margin-top: 1.5pt; margin-right: 0in; margin-bottom: 1.5pt; font-size: 10pt; font-family: Calibri, sans-serif;"><span style="font-size: 10pt; font-family: arial, helvetica, sans-serif;">Conducts thorough, thoughtful reviews of healthcare claims and medical records to identify discrepancies between the physician documentation, the clinical picture depicted in the record, the codes billed, and the resulting DRG</span></li> <li style="color: black; background: white; margin-top: 1.5pt; margin-right: 0in; margin-bottom: 1.5pt; font-size: 10pt; font-family: Calibri, sans-serif;"><span style="font-size: 10pt; font-family: arial, helvetica, sans-serif;">Appropriately uses industry-recognized references to support review findings, including the ICD-10-CM and ICD-10-PCS Official Guidelines for Coding and Reporting, AHIMA Standards of Ethical Coding, AHIMA Practice Briefs related to compliant querying, and AHA Coding Clinics</span></li> <li style="color: black; background: white; margin-top: 1.5pt; margin-right: 0in; margin-bottom: 1.5pt; font-size: 10pt; font-family: Calibri, sans-serif;"><span style="font-size: 10pt; font-family: arial, helvetica, sans-serif;">Writes complete, clear, and accurate rationale to support audit determinations, citing specific information from the record, and referencing appropriate guidelines, policies, regulations, and/or Coding advice</span></li> </ul> <ul style="margin-bottom: 0in; margin-top: 2px;"> <li style="margin: 1.5pt 0in 0in 0px; font-size: 10pt; font-family: Calibri, sans-serif;"><span style="color: black; font-size: 10pt; font-family: arial, helvetica, sans-serif;">Keeps abreast of coding, clinical, regulatory, and other industry changes that impact Penstock auditing and/or that suggest new audit opportunities</span></li> <li style="background: white; margin: 0in 0in 1.5pt 0px; font-size: 10pt; font-family: Calibri, sans-serif;"><span style="color: black; font-size: 10pt; font-family: arial, helvetica, sans-serif;">Maintains focus on the identification and development of new audit concepts</span></li> </ul> <ul style="margin-bottom: 0in; margin-top: 2px;" type="disc"> <li style="color: black; background: white; margin-top: 1.5pt; margin-right: 0in; margin-bottom: 1.5pt; font-size: 10pt; font-family: Calibri, sans-serif;"><span style="font-size: 10pt; font-family: arial, helvetica, sans-serif;">Continuously considers the systems and processes involved with healthcare reimbursement (both internal and external) and communicates ideas for improvement through appropriate channels</span></li> <li style="color: rgb(45, 45, 45); margin-top: 1.5pt; margin-right: 0in; margin-bottom: 1.5pt; font-size: 10pt; font-family: Calibri, sans-serif;"><span style="font-size: 10pt; font-family: arial, helvetica, sans-serif;">Participates in focused training to learn new auditing skills across a myriad of clinical and coding scenarios</span></li> <li style="color: black; background: white; margin-top: 1.5pt; margin-right: 0in; margin-bottom: 1.5pt; font-size: 10pt; font-family: Calibri, sans-serif;"><span style="font-size: 10pt; font-family: arial, helvetica, sans-serif;">Communicates kindly, professionally, and effectively with all customers, both internal and external, and refers issues to management as appropriate</span></li> </ul> <ul style="margin-bottom: 0in; margin-top: 2px;" type="disc"> <li style="margin: 1.5pt 0in 0in 0px; font-size: 10pt; font-family: Calibri, sans-serif;"><span style="color: black; font-size: 10pt; font-family: arial, helvetica, sans-serif;">Continuously strives to find new avenues for fulfilling the Penstock mission of reclaiming greater integrity between payors and providers </span></li> <li style="margin: 0in 0in 1.5pt 0px; font-size: 10pt; font-family: Calibri, sans-serif;"><span style="color: black; font-size: 10pt; font-family: arial, helvetica, sans-serif;">Serves as a Payment Integrity subject matter expert for Penstock team members and for the Goodroot organization as a whole</span></li> <li style="background: white; margin-top: 1.5pt; margin-right: 0in; margin-bottom: 1.5pt; font-size: 10pt; font-family: Calibri, sans-serif;"><span style="color: black; font-size: 10pt; font-family: arial, helvetica, sans-serif;">Meets or exceeds Penstock’s performance and quality standards.</span></li> <li style="background: white; margin-top: 1.5pt; margin-right: 0in; margin-bottom: 1.5pt; font-size: 10pt; font-family: Calibri, sans-serif;"><span style="color: black; font-size: 10pt; font-family: arial, helvetica, sans-serif;">Senior Auditor positions provide support for Team Lead as required.</span></li> </ul> <p> </p> <p><strong><span style="font-family: arial, helvetica, sans-serif;"><span style="font-size: 13.3333px;">Qualifications and Education Requirements </span></span></strong></p> <ul style="margin-bottom: 0in; margin-top: 2px;" type="disc"> <li style="color: rgb(45, 45, 45); margin-top: 1.5pt; margin-right: 0in; margin-bottom: 1.5pt; font-size: 10pt; font-family: Calibri, sans-serif;"><span style="font-size: 10pt; font-family: arial, helvetica, sans-serif;">Minimum of an associate degree</span></li> <li style="color: rgb(45, 45, 45); margin-top: 1.5pt; margin-right: 0in; margin-bottom: 1.5pt; font-size: 10pt; font-family: Calibri, sans-serif;"><span style="font-size: 10pt; font-family: arial, helvetica, sans-serif;">Current AHIMA Health Information Management credential(s): RHIT or RHIA</span></li> <li style="color: rgb(45, 45, 45); margin-top: 1.5pt; margin-right: 0in; margin-bottom: 1.5pt; font-size: 10pt; font-family: Calibri, sans-serif;"><span style="font-size: 10pt; font-family: arial, helvetica, sans-serif;">Current AHIMA/AAPC Coding Credential: CCS or CIC</span></li> <li style="color: rgb(45, 45, 45); margin-top: 1.5pt; margin-right: 0in; margin-bottom: 1.5pt; font-size: 10pt; font-family: Calibri, sans-serif;"><span style="font-size: 10pt; font-family: arial, helvetica, sans-serif;">Current Clinical Validation credential(s): CDIP, CCDS, or CDEI</span></li> <li style="color: rgb(45, 45, 45); margin-top: 1.5pt; margin-right: 0in; margin-bottom: 1.5pt; font-size: 10pt; font-family: Calibri, sans-serif;"><span style="font-size: 10pt; font-family: arial, helvetica, sans-serif;">3 or more years of ICD-10 inpatient coding experience</span></li> <li style="color: rgb(45, 45, 45); margin-top: 1.5pt; margin-right: 0in; margin-bottom: 1.5pt; font-size: 10pt; font-family: Calibri, sans-serif;"><span style="font-size: 10pt; font-family: arial, helvetica, sans-serif;">1 or more years of clinical experience in a healthcare facility setting</span></li> <li style="color: rgb(45, 45, 45); margin-top: 1.5pt; margin-right: 0in; margin-bottom: 1.5pt; font-size: 10pt; font-family: Calibri, sans-serif;"><span style="font-size: 10pt; font-family: arial, helvetica, sans-serif;">3 or more years of auditing experience (or demonstrated equivalent)</span></li> <li style="color: rgb(45, 45, 45); margin-top: 1.5pt; margin-right: 0in; margin-bottom: 1.5pt; font-size: 10pt; font-family: Calibri, sans-serif;"><span style="font-size: 10pt; font-family: arial, helvetica, sans-serif;">1 or more years of auditing experience in a payor setting</span></li> <li style="color: rgb(45, 45, 45); margin-top: 1.5pt; margin-right: 0in; margin-bottom: 1.5pt; font-size: 10pt; font-family: Calibri, sans-serif;"><span style="font-size: 10pt; font-family: arial, helvetica, sans-serif;">1 or more years of experience in Inpatient Rehabilitation coding/auditing</span></li> <li style="color: rgb(45, 45, 45); margin-top: 1.5pt; margin-right: 0in; margin-bottom: 1.5pt; font-size: 10pt; font-family: Calibri, sans-serif;"><span style="font-size: 10pt; font-family: arial, helvetica, sans-serif;">1 or more years of experience in Inpatient Psychiatric coding/auditing</span></li> <li style="color: rgb(45, 45, 45); margin-top: 1.5pt; margin-right: 0in; margin-bottom: 1.5pt; font-size: 10pt; font-family: Calibri, sans-serif;"><span style="font-size: 10pt; font-family: arial, helvetica, sans-serif;">Comprehensive understanding of ICD-10-CM Inpatient Coding Guidelines, AHA Coding Clinic, and DRG grouping mechanics</span></li> <li style="color: rgb(45, 45, 45); margin-top: 1.5pt; margin-right: 0in; margin-bottom: 1.5pt; font-size: 10pt; font-family: Calibri, sans-serif;"><span style="font-size: 10pt; font-family: arial, helvetica, sans-serif;">Strong current clinical knowledgebase</span></li> <li style="color: rgb(45, 45, 45); margin-top: 1.5pt; margin-right: 0in; margin-bottom: 1.5pt; font-size: 10pt; font-family: Calibri, sans-serif;"><span style="font-size: 10pt; font-family: arial, helvetica, sans-serif;">Familiarity with Clinical Documentation Integrity practices</span></li> <li style="color: rgb(45, 45, 45); margin-top: 1.5pt; margin-right: 0in; margin-bottom: 1.5pt; font-size: 10pt; font-family: Calibri, sans-serif;"><span style="font-size: 10pt; font-family: arial, helvetica, sans-serif;">Awareness of and adherence to HIPAA, and all laws regarding the safeguarding of PHI/PII</span></li> <li style="color: rgb(45, 45, 45); margin-top: 1.5pt; margin-right: 0in; margin-bottom: 1.5pt; font-size: 10pt; font-family: Calibri, sans-serif;"><span style="font-size: 10pt; font-family: arial, helvetica, sans-serif;">Ability to conduct independent research using credible sources</span></li> <li style="color: rgb(45, 45, 45); margin-top: 1.5pt; margin-right: 0in; margin-bottom: 1.5pt; font-size: 10pt; font-family: Calibri, sans-serif;"><span style="font-size: 10pt; font-family: arial, helvetica, sans-serif;">Demonstrated working knowledge of Microsoft Word, Excel, and PowerPoint</span></li> <li style="color: rgb(45, 45, 45); margin-top: 1.5pt; margin-right: 0in; margin-bottom: 1.5pt; font-size: 10pt; font-family: Calibri, sans-serif;"><span style="font-size: 10pt; font-family: arial, helvetica, sans-serif;">Ability to apply critical thinking skills to record reviews</span></li> <li style="color: rgb(45, 45, 45); margin-top: 1.5pt; margin-right: 0in; margin-bottom: 1.5pt; font-size: 10pt; font-family: Calibri, sans-serif;"><span style="font-size: 10pt; font-family: arial, helvetica, sans-serif;">Ability to work independently, manage workload, and adapt to shifting priorities</span></li> <li style="color: rgb(45, 45, 45); margin-top: 1.5pt; margin-right: 0in; margin-bottom: 1.5pt; font-size: 10pt; font-family: Calibri, sans-serif;"><span style="font-size: 10pt; font-family: arial, helvetica, sans-serif;">Willingness to adapt and learn new auditing skills across a myriad of coding and clinical scenarios</span></li> <li style="color: rgb(45, 45, 45); margin-top: 1.5pt; margin-right: 0in; margin-bottom: 1.5pt; font-size: 10pt; font-family: Calibri, sans-serif;"><span style="font-size: 10pt; font-family: arial, helvetica, sans-serif;">Excellent communication skills, both oral and written</span></li> <li style="color: rgb(45, 45, 45); margin-top: 1.5pt; margin-right: 0in; margin-bottom: 1.5pt; font-size: 10pt; font-family: Calibri, sans-serif;"><span style="font-size: 10pt; font-family: arial, helvetica, sans-serif;">Comfortable working in an ever-changing fast paced environment</span></li> <li style="color: rgb(45, 45, 45); margin-top: 1.5pt; margin-right: 0in; margin-bottom: 1.5pt; font-size: 10pt; font-family: Calibri, sans-serif;"><span style="font-size: 10pt; font-family: arial, helvetica, sans-serif;">Able to work Eastern time zone hours</span></li> <li style="color: rgb(45, 45, 45); margin-top: 1.5pt; margin-right: 0in; margin-bottom: 1.5pt; font-size: 10pt; font-family: Calibri, sans-serif;"><span style="font-size: 10pt; font-family: arial, helvetica, sans-serif;">Secure and private home office with reliable high-speed internet connection</span></li> </ul> <p> </p> <p><strong><span style="font-size: 10pt; font-family: arial, helvetica, sans-serif;">Preferred Skills</span></strong></p> <ul style="margin-bottom: 0in; margin-top: 2px;"> <li style="margin: 1.5pt 0in 0in 0px; font-size: 10pt; font-family: Calibri, sans-serif;"><span style="color: rgb(45, 45, 45); font-size: 10pt; font-family: arial, helvetica, sans-serif;">Bachelor’s degree</span></li> <li style="margin: 0in 0in 0in 0px; font-size: 10pt; font-family: Calibri, sans-serif;"><span style="color: rgb(45, 45, 45); font-size: 10pt; font-family: arial, helvetica, sans-serif;">AHIMA/AAPC/ACDIS Auditing Credential: Auditing: Inpatient Coding Microcredential through AHIMA, Certified Professional Medical Auditor (CPMA) through AAPC</span></li> <li style="margin: 0in 0in 1.5pt 0px; font-size: 10pt; font-family: Calibri, sans-serif;"><span style="color: rgb(45, 45, 45); font-size: 10pt; font-family: arial, helvetica, sans-serif;">5+ years of inpatient ICD-10 coding and auditing experience</span></li> </ul> <ul style="margin-bottom: 0in; margin-top: 2px;" type="disc"> <li style="color: rgb(22, 22, 22); background: white; margin-top: 1.5pt; margin-right: 0in; margin-bottom: 1.5pt; font-size: 10pt; font-family: Calibri, sans-serif;"><span style="font-size: 10pt; font-family: arial, helvetica, sans-serif;">5+ years of relevant auditing (clinical validation and medical necessity) experience</span></li> </ul> <ul style="margin-bottom: 0in; margin-top: 2px;"> <li style="margin: 1.5pt 0in 0in 0px; font-size: 10pt; font-family: Calibri, sans-serif;"><span style="color: rgb(45, 45, 45); font-size: 10pt; font-family: arial, helvetica, sans-serif;">AHIMA/AAPC Coding Certifications (RHIA, RHIT, CCS, CPC, CPC-H), AHIMA/ACDIS Clinical Documentation Certification (CDIP, CCDS), or Clinical Documentation Integrity experience</span></li> <li style="margin: 0in 0in 0in 0px; font-size: 10pt; font-family: Calibri, sans-serif;"><span style="color: rgb(45, 45, 45); font-size: 10pt; font-family: arial, helvetica, sans-serif;">1-5 years of Inpatient Rehabilitation Coding/Auditing </span></li> <li style="margin: 0in 0in 1.5pt 0px; font-size: 10pt; font-family: Calibri, sans-serif;"><span style="color: rgb(45, 45, 45); font-size: 10pt; font-family: arial, helvetica, sans-serif;">1-5 years of Inpatient Psychiatric Coding/Auditing</span></li> </ul> <p> </p> <p><span style="font-family: arial, helvetica, sans-serif; font-size: 10pt;">Penstock is an affiliate company of Goodroot, which launches and grows companies dedicated to putting patients back in the center of healthcare. Penstock is an Equal Opportunity Employer. </span></p> <p><span style="font-family: arial, helvetica, sans-serif; font-size: 10pt;">About Goodroot</span></p> <p><span style="font-family: arial, helvetica, sans-serif; font-size: 10pt;">Goodroot is a community of companies committed to delivering more access to better healthcare at a lower cost. With a growing group of brands including, but not limited to Penstock, Navion, and Emry, Goodroot is reshaping healthcare for good, one system at a time. Learn more at <a href="https://hhfchealth1-my.sharepoint.com/personal/tcoskren_goodrootinc_com/Documents/Documents/People%20Strategy/Hiring/www.goodrootinc.com" rel="nofollow">www.goodrootinc.com</a>.</span></p> <h1 style="margin: 6pt 0in; font-size: 11pt; font-family: Calibri, sans-serif; font-variant: small-caps;"> </h1>
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