Medical Coder

Insight Global; Metro Manila; On-site; PHP 3,769,000 - 5,653,000; Full time

Job summary

Insight Global is seeking a qualified inpatient coding auditor to perform retrospective DRG audits for U.S. hospital clients. You will validate diagnoses and procedures, review CC/MCC capture, and support clinical validity with documentation quality analysis.

The role requires ICD-10-CM/PCS expertise, CMS regulations knowledge, and collaboration across CDI, coding, and quality teams to ensure audit readiness and accurate reimbursements.

Qualifications

• RN, CCS, CPC, CCDS, or CDIP credential required.
• 2+ years of inpatient coding, CDI, or DRG validation experience.
• Hands-on experience auditing inpatient charts for U.S. hospitals.
• Strong knowledge of ICD-10-CM/PCS coding guidelines and MS-DRG assignment.
• Experience reviewing CC/MCC capture, clinical validity, and documentation quality.
• Understanding of physician documentation standards and coding compliance requirements.
• Familiarity with CMS regulations and Coding Clinic guidance.

Responsibilities

• Perform retrospective inpatient DRG audits for U.S. hospital clients
• Validate principal diagnoses, secondary diagnoses, procedures, and DRG assignments
• Review charts for accurate CC/MCC capture, SOI/ROM, and clinical validity
• Identify DRG shifts, missed diagnoses, coding opportunities, and documentation gaps
• Provide clear audit findings supported by clinical and coding rationale
• Document audit results within client tools and reporting templates
• Collaborate with CDI, coding, quality, and audit teams
• Support compliance, reimbursement integrity, and audit readiness initiatives

Skills

RN credential

CCS

CPC

CCDS

CDIP

Inpatient coding experience

DRG assignment knowledge

Job description

What we're looking for:

• RN, CCS, CPC, CCDS, or CDIP credential
• 2+ years of inpatient coding, CDI, or DRG validation experience
• Hands-on experience auditing inpatient charts for U.S. hospitals
• Strong knowledge of ICD-10-CM/PCS coding guidelines and MS-DRG assignment
• Experience reviewing CC/MCC capture, clinical validity, and documentation quality
• Understanding of physician documentation standards and coding compliance requirements
• Familiarity with CMS regulations and Coding Clinic guidance

Key responsibilities:

• Perform retrospective inpatient DRG audits for U.S. hospital clients
• Validate principal diagnoses, secondary diagnoses, procedures, and DRG assignments
• Review charts for accurate CC/MCC capture, SOI/ROM, and clinical validity
• Identify DRG shifts, missed diagnoses, coding opportunities, and documentation gaps
• Provide clear audit findings supported by clinical and coding rationale
• Document audit results within client tools and reporting templates
• Collaborate with CDI, coding, quality, and audit teams
• Support compliance, reimbursement integrity, and audit readiness initiatives