DRG Auditor

Summary :

Our award-winning client is seeking a DRG Auditor to join their team. The primary goal of this position is to ensure the integrity and accuracy of inpatient claims. As a DRG Auditor, you will perform in-depth reviews of medical records and billed claims to validate coding accuracy, ensure compliance with official guidelines, correct errors, and ultimately optimize revenue through precise DRG assignment. This role requires expert knowledge in both coding principles and regulatory standards.

Responsibilities :

Claim Validation & Compliance : Conduct comprehensive analysis and review of inpatient claims, strictly adhering to Official Coding and Reporting Guidelines. Validate reported ICD-10-CM / PCS codes to ensure the most accurate and appropriate DRG

assignment for billing.

Medical Record Review : Perform detailed reviews of medical records and screening referrals to confirm that the clinical documentation fully supports the coded diagnoses and procedures.

Error Correction & Revenue Optimization : Identify coding, documentation, and billing errors, implement necessary corrections, and suggest process improvements to enhance revenue integrity and overall documentation quality.

Collaboration : Effectively consult and collaborate with physician reviewers and other clinical staff to resolve complex or ambiguous cases.

Workflow Management : Manage, prioritize, and organize a full audit workload, demonstrating the ability to independently meet productivity and quality goals.

Professional Development : Attend all mandatory departmental team meetings, training sessions, and remain current on changes to coding guidelines and regulatory mandates.

Other Duties : Complete additional tasks or special projects as assigned by leadership.

Required Qualifications :

Coding Certification (Mandatory) : Must possess and maintain at least one of the following active certifications as a condition of employment :

○ Certified Coding Specialist (CCS).

○ Certified Inpatient Coder (CIC).

Inpatient Auditing Experience : A minimum of 3 years of experience in acute care inpatient coding, auditing, and validation of MS-DRG and APR-DRG assignments.

Preferred Skills :

Prior experience in Payment Integrity or utilization review / DRG validation is highly desirable.