CGI Technologies and Solutions, Inc. DRG Validation Auditor in USA, United States
DRG Validation Auditor
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Category:Business Consulting, Strategy and Digital Transformation
City:USA, Other, United States
Employment Type:Full Time
Meet our professionals
CGI: An employer of choice offering a global health and wellness program
DRG Validation Auditors are members of the CGI Federal’s Healthcare Compliance Team, with responsibility for reviewing medical records to determine the accuracy of coding and reimbursement for clinical services rendered to beneficiaries of health plans, including Commercial and Government Clients.
Your future duties and responsibilities:
• Reviews inpatient medical records to validate, assignment and sequencing of ICD-9-CM and ICD-10 diagnosis and procedure codes, discharge status codes, and DRG assignment
• Provides a detailed rationale for every medical record review resulting in a DRG Review Results letter, including supporting references
• Follows proper procedure for referral to Clinical Nurse Auditor or Physician Advisor, as applicable
• Utilizes proper reference material, standards, and guidelines for coding
• Provides input to the Edit Development team on claims selection criteria
• Verifies data received from client and work to resolve discrepancies
• If the contract requires onsite review, interacts with Providers and other personnel in a professional manner
• Follows CGI Federal policies and processes, completing timesheets, payroll, travel expense documents, and other corporate requirements in a timely manner
• Communicates timely with Team Lead regarding illnesses, appointments, vacation requests, changes in work schedule, performance barriers, and computer issues
• Complies with department standards regarding productivity and audit quality
• Performs other duties as assigned
Required qualifications to be successful in this role:
• Possesses current AHIMA credentials (RHIT/RHIA/CCS), with current CCS preferred
• Demonstrates extensive knowledge of ICD-9-CM and ICD-10 coding and DRG reimbursement, with a minimum of five years of inpatient coding experience.
• Previous experience training and mentoring junior-level coders is highly desired.
• Must understand government and commercial provider reimbursement methodologies, and possesses strong data analytic skills
• Working knowledge of computer functions and applications such as Microsoft Office (Outlook, Word, Excel) and Windows operating systems is required
• Ability to write a well-reasoned review in a narrative style, with accurate spelling, grammar and syntax
• Must be able to adapt to changing priorities in order to meet Client requirements, and is required to meet department productivity standards and deadlines
• Auditors may be required to travel for additional training and on-site reviews on an as-needed basis
•Must be able to pass a moderate background investigation, depending on Client requirements
What you can expect from us:
Build your career with us.
It is an extraordinary time to be in business. As digital transformation continues to accelerate, CGI is at the center of this change—supporting our clients’ digital journeys and offering our professionals exciting career opportunities.
At CGI, our success comes from the talent and commitment of our professionals. As one team, we share the challenges and rewards that come from growing our company, which reinforces our culture of ownership. All of our professionals benefit from the value we collectively create.
Be part of building one of the largest independent technology and business services firms in the world.
Learn more about CGI at www.cgi.com .
No unsolicited agency referrals please.
CGI is an equal opportunity employer.
Qualified applicants will receive consideration for employment without regard to their race, ethnicity, ancestry, color, sex, religion, creed, age, national origin, citizenship status, disability, medical condition, military and veteran status, marital status, sexual orientation or perceived sexual orientation, gender, gender identity, and gender expression, familial status, political affiliation, genetic information, or any other legally protected status or characteristics.
CGI provides reasonable accommodations to qualified individuals with disabilities. If you need an accommodation to apply for a job in the U.S., please email the CGI U.S. Employment Compliance mailbox at USEmploymentCompliance@cgi.com . You will need to reference the requisition number of the position in which you are interested. Your message will be routed to the appropriate recruiter who will assist you. Please note, this email address is only to be used for those individuals who need an accommodation to apply for a job. Emails for any other reason or those that do not include a requisition number will not be returned .
We make it easy to translate military experience and skills! Click here at https://cgi-veterans.jobs/ to be directed to our site that is dedicated to veterans and transitioning service members.
All CGI offers of employment in the U.S. are contingent upon the ability to successfully complete a background investigation. Background investigation components can vary dependent upon specific assignment and/or level of US government security clearance held.
CGI will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with CGI’s legal duty to furnish information.
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CGI is committed to the principles of equal employment opportunity and to compliance with US laws and regulations. Click here at http://documents.njoyn.com/homebase/cgi/AMSDocs/EEOPolicy-Signed2017.pdf to access our US EEO/Affirmative action policy.
Applicants have rights under Federal Employment Laws:
EPPA at https://www.dol.gov/whd/regs/compliance/posters/eppac.pdf
FMLA at https://www.dol.gov/whd/regs/compliance/posters/fmlaen.pdf
Consolidated EEO Is The Law at http://documents.njoyn.com/homebase/cgi/AMSDocs/EEO_Poster.pdf
CGI provides reasonable accommodations to qualified individuals with disabilities. If you need an accommodation to apply for a job in the U.S., please email the CGI U.S. Employment Compliance mailbox at USEmploymentCompliance@cgi.com . You will need to reference the requisition number of the position in which you are interested. Your message will be routed to the appropriate recruiter who will assist you. Please note, this email address is only to be used for those individuals who need an accommodation to apply for a job. Emails for any other reason or those that do not include a requisition number will not be returned.
We make it easy to translate military experience and skills! Click here at http://cgi-veterans.jobs/ to be directed to our site that is dedicated to veterans and transitioning service members.