CorVel Corporation ยท 2 months ago
Clinical Review Auditor
United States
Full-time
Remote
Mid, Senior Level
$69K/yr - $105K/yrCorVel Corporation is a stable and growing company committed to accuracy and transparency in healthcare payments. The DRG Clinical Auditor will perform DRG validation reviews of medical records, ensuring the accuracy of coding and compliance with payer rules, while providing clinical support for determinations.
InsuranceSoftware
Responsibilities
The Clinical Auditor will review medical records to determine accuracy of billing through verification of coding and review of supporting clinical documentation
Conduct audits to ensure accurate reimbursement and identifying potential savings
Demonstrated knowledge of ICD-10-CM codes, PCS and DRG coding, understanding of payer rules and regulations, including Medicare and Medicaid
Understand and comply with all internal and external policies
Working knowledge of HIPAA Privacy and Security Rules
Assist Quality Control team and medical director with appeals, rebuttals, etc
Notify leadership of any issues or concerns in a timely manner
Additional duties as assigned
Qualification
Required
Performing DRG validation (clinical/coding) reviews of medical records and/or other documentation
Determine correct DRG/coding as defined by review methodologies specific to the type of review
Completing medical record reviews, accurately documenting findings and non-findings
Providing clinical/policy/regulatory support for the determination
Utilize experience with ICD-10-CM & PCS coding guidelines
Ability to understand modern pharmacology, disease management and clinical intervention procedures
Strong written and verbal communication skills
Clinical knowledge of disease processes
Knowledge of medical necessity rules
Review medical records to determine accuracy of billing through verification of coding and review of supporting clinical documentation
Conduct audits to ensure accurate reimbursement and identifying potential savings
Demonstrated knowledge of ICD-10-CM codes, PCS and DRG coding
Understanding of payer rules and regulations, including Medicare and Medicaid
Understand and comply with all internal and external policies
Working knowledge of HIPAA Privacy and Security Rules
Assist Quality Control team and medical director with appeals, rebuttals, etc
Notify leadership of any issues or concerns in a timely manner
Proficient understanding of Medicare, CMS guidelines and ICD-10 coding guidelines
Effective and professional communication skills, both verbal and written
Ability to work independently and in a team environment
High attention to detail
Must possess critical thinking skills
Ability to multi-task and assist with team coverage and provide support when needed
Ability to build relationships both internally and externally
Ability to work in a fast-paced environment
Demonstrated proficiency in basic computer skills and typing
Proficiency with Microsoft Office
CCS or CIC required with DRG auditing experience in ICD-10-CM, ICD-10 PCS
Preferred
LVN or RN license in the state of employment preferred
Experience in the OR, ICU, or ER as an RN highly preferred
Benefits
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
Paid time off
Company
CorVel Corporation
CorVel is a nationally recognized claims management and managed care provider with over 30 years of experience in the industry.
Founded in 1987
1001-5000 employees
Funding
Current Stage
Public CompanyTotal Funding
unknown1991-07-05IPO
Leadership Team
Jeff Gurtcheff
Chief Claims Officer
Maxim Shishin
CIO
Recent News
CorVel Corp.
2025-11-04
2025-10-22
2025-10-06
Company data provided by crunchbase