DRG Revenue Integrity Auditor

CorroHealth•TX-Remote, TX

3d•Remote

About The Position

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success. Are you a passionate coding and revenue integrity professional who thrives on clinical accuracy, continuous learning, and making a meaningful impact? At CorroHealth, you'll work alongside some of the nation's most respected physicians, clinical leaders, coding experts, and healthcare innovators to ensure the highest standards of coding accuracy and revenue integrity for leading healthcare organizations. As a global healthcare solutions company, we invest in our people through continued education, career advancement opportunities, mentorship from industry experts, and a flexible work environment that supports work-life balance. If you're looking for an opportunity to elevate your expertise while partnering with exceptional clients and colleagues, we'd love to hear from you.

Requirements

DRG validation and quality audits on inpatient medical records
Accurate representation of each patient's clinical story
Detailed DRG validation reviews of inpatient charts
Ensure assigned ICD-10-CM/PCS codes accurately reflect the patient's clinical condition and treatment
Validate proper sequencing and accuracy of diagnoses and procedures
Review and assess Present on Admission (POA) indicators
Review and assess Severity of Illness (SOI)
Review and assess Risk of Mortality (ROM)
Review and assess Case Mix Index (CMI)
Review and assess Hierarchical Condition Category (HCC) capture
Review and assess Other coding and reimbursement factors
Utilize current coding references and clinical criteria
Adhere to coding guidelines and CDI best practices endorsed by AHIMA and ACDIS
Identify documentation gaps and formulate compliant physician queries
Analyze records for coding opportunities, sequencing accuracy, and clinical support
Maintain high-quality review standards
Meet productivity and quality expectations
Stay current with regulatory, coding, reimbursement, and clinical documentation updates
Support development of training content and educational resources
Mentor and provide shadowing opportunities for new team members
Assist with project analysis, reporting, and client-facing feedback initiatives
Participate in internal and external audits of Clinical Documentation Integrity (CDI) programs
Protect patient privacy and ensure proper handling of all PHI in accordance with company policies and regulatory requirements
Attend required meetings, training sessions, and educational programs

Nice To Haves

Passionate coding and revenue integrity professional
Thrives on clinical accuracy, continuous learning, and making a meaningful impact
Work alongside some of the nation's most respected physicians, clinical leaders, coding experts, and healthcare innovators
Ensure the highest standards of coding accuracy and revenue integrity for leading healthcare organizations
Invest in our people through continued education, career advancement opportunities, mentorship from industry experts, and a flexible work environment that supports work-life balance
Elevate your expertise while partnering with exceptional clients and colleagues

Responsibilities

Performs comprehensive Diagnostic Related Group (DRG) validation and quality audits on inpatient medical records to ensure accurate representation of each patient's clinical story.
Perform detailed DRG validation reviews of inpatient charts.
Ensure assigned ICD-10-CM/PCS codes accurately reflect the patient's clinical condition and treatment.
Validate proper sequencing and accuracy of diagnoses and procedures.
Review and assess: Present on Admission (POA) indicators, Severity of Illness (SOI), Risk of Mortality (ROM), Case Mix Index (CMI), Hierarchical Condition Category (HCC) capture, and Other coding and reimbursement factors.
Utilize current coding references and clinical criteria including: ICD-10-CM/PCS, CMS Guidelines, MCG, InterQual, National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), Payer clinical policy guidelines.
Adhere to coding guidelines and CDI best practices endorsed by AHIMA and ACDIS.
Identify documentation gaps and formulate compliant physician queries when appropriate.
Analyze records for coding opportunities, sequencing accuracy, and clinical support.
Maintain high-quality review standards while meeting productivity and quality expectations.
Stay current with regulatory, coding, reimbursement, and clinical documentation updates.
Support development of training content and educational resources.
Mentor and provide shadowing opportunities for new team members.
Assist with project analysis, reporting, and client-facing feedback initiatives.
Participate in internal and external audits of Clinical Documentation Integrity (CDI) programs.
Protect patient privacy and ensure proper handling of all PHI in accordance with company policies and regulatory requirements.
Attend required meetings, training sessions, and educational programs.
Perform other duties as assigned.