Clinical Nurse Specialist Job at VDart Inc, Remote

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  • VDart Inc
  • Remote

Job Description

Job Description:

Title: Clinical Nurse Specialist Remote

REQUIRED: ACTIVE RN LICENSE (multi-state preferred)

Key Responsibilities:

  • Perform clinical coding and DRG validation for various service types.
  • Review claims for accuracy and severity of stay based on appropriate diagnosis codes.
  • Apply CMS guidelines, state policies, and payer requirements in coding processes.
  • Support appeals and reconsiderations, including Medicaid-related cases.
  • Collaborate with vendors and internal teams on coding and editing systems.
  • Ensure compliance with coding certifications and payer policies.

Qualifications:

  • Active RN license (multi-state preferred) OR Certified Coding Specialist (CCS), Certified Inpatient Coder (CIC), CPC, CSS, RHIT, or equivalent credential.
  • Minimum 3 5 years of experience in clinical coding and DRG validation.
  • Strong knowledge of CMS guidelines, payer policies, and therapy benefit structures.
  • Experience with reconsiderations, appeals, and code editing (CPC experience preferred).
  • Medicaid experience strongly preferred.
  • Ability to teach systems and code editor tools; prior coding experience required.

Preferred Skills:

  • Familiarity with state-specific coding policies and written guidelines.
  • Knowledge of all service types and payer structures.
  • Strong analytical and organizational skills.
  • Years of Experience:3.00 Years of Experience

Job Tags

Remote work,

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