DRG Revenue Integrity Auditor

The DRG Revenue Integrity Auditor is responsible for conducting inpatient chart reviews to validate Diagnostic Related Group (DRG) assignments and ensure accurate coding that reflects the patient’s true clinical picture. This role supports compliant reimbursement and upholds documentation integrity by working closely with coding, CDI, and clinical teams.

This job will have the following responsibilities :

• Review and analyze inpatient medical records to validate diagnoses, procedures, and DRG assignments
• Ensure accurate ICD-10-CM and ICD-10-PCS code sequencing and POA indicators in accordance with official coding guidelines
• Evaluate clinical documentation for severity of illness (SOI), risk of mortality (ROM), HCC capture, and case mix index (CMI) accuracy
• Identify query opportunities and compose compliant queries to clarify documentation discrepancies
• Utilize EHR systems and coding software to perform audits and maintain accurate records
• Apply current clinical criteria (MCG, InterQual), CMS guidelines, NCDs / LCDs, and payer policies during chart reviews
• Maintain high levels of accuracy and productivity, meeting established quality and production metrics
• Stay current with coding clinics, regulatory updates, and CDI best practices endorsed by ACDIS and AHIMA
• Collaborate with physicians, CDI specialists, and revenue cycle teams to resolve coding-related issues and support claim integrity

Qualifications & Requirements :