POSTED: April 23,2008

Health Net

Mgr DRG/Recoupment (#08001145)

For a complete job description and to apply online, visit us at www.careersathealthnet.com
Enter Job Number 08001145

JOB SUMMARY:

This position is responsible to manage, plan and implement the Peer Review Organization functions for all regions, including oversight of DRG validation and recoupment activities.

REQUIREMENTS:

Certification/License: 
Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA)

Experience:
• Minimum three years acute care experience.
• Two years managed care experience and one year supervisory experience.
• Desire familiarity with computer applications such as spreadsheets and databases, auditing experience and knowledge of TRICARE policies and procedures, TRICARE claims systems and retrospective review system.

Knowledge, Skills & Abilities:
• Demonstrates knowledge of DRG validation process.
• Demonstrates knowledge of coding guidelines and conventions.
• Knowledge of national quality standards, state and federal laws relating to review for coding validation, and knowledge of a variety of clinical specialty areas of medical treatment, practice and procedures.

As a government contractor, this position requires U. S. citizenship and proof of favorable adjudication following submission of Department of Defense form SF85P or higher security.