DRG Coding Auditor - MS-DRG and APR-DRG
About The Position
The DRG Coding Auditor audits inpatient medical records and performs clinical reviews of medical records and related documentation to assess coding and DRG assignment accuracy. The role specializes in reviewing DRG coding using medical records and attending physician statements submitted by acute care hospitals. The auditor generates high-quality recoverable claims for the company and its clients across all lines of business. This position is described as virtual full-time, with in-person training sessions required. Candidates generally must live within reasonable commuting distance of a posting location unless an accommodation is granted. Alternate locations may be considered for candidates within commuting distance of an office.
Requirements
- An associate degree (AA/AS) or at least five years of experience in claims auditing, quality assurance, or recovery auditing.
- At least one of the following certifications: RHIA, RHIT, CCS, CIC, or CCDS.
- Five years of experience working with ICD-9/10-CM, MS-DRG, AP-DRG, and APR-DRG.
Nice To Haves
- Bachelor’s degree (BA/BS).
- Experience in a vendor-based DRG coding or clinical validation audit setting, or in a hospital coding or quality assurance environment.
- Broad knowledge of medical claims billing and payment systems, provider billing guidelines, payer reimbursement policies, billing validation criteria, and coding terminology.
Responsibilities
- Analyze and audit claims by integrating medical chart coding principles, clinical guidelines, and objective medical audit practices.
- Apply advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to support audit conclusions.
- Use audit tools, workflow systems, and reference information to make audit determinations and prepare audit findings letters.
- Maintain accuracy and quality standards for audit concepts, valid claim identification, and documentation, including letter writing.
- Identify potential claims outside current audit concepts where additional recoveries may be available, such as readmissions, inpatient-to-outpatient cases, and HACs.
- Recommend and develop high-quality, high-value audit concepts, process improvements, and efficiency improvements.
Benefits
- Comprehensive benefits package, subject to eligibility requirements.
- Incentive and recognition programs.
- Equity stock purchase plan.
- 401(k) contribution and matching.
- Paid holidays.
- Paid time off.
- Medical insurance.
- Dental insurance.
- Vision insurance.
- Short- and long-term disability benefits.
- Life insurance.
- Wellness programs.
- Financial education resources.
- Sign-on bonus of $1,500.
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What This Job Offers
Job Type
Full-time
Education Level
Associate degree
