Certified DRG Auditor (CCS) – Remote

EnableComp; United States; Hybrid; USD 65,000 - 90,000; Full time

Job summary

EnableComp is seeking a DRG Auditor to review post-billed inpatient claims, validate missed reimbursement opportunities, and optimize hospital reimbursement. The role requires ICD-10 coding expertise and CCS certification, with experience in DRG validation and post-bill coding.

Responsibilities include analyzing inpatient claims, conducting medical record reviews, and identifying DRG coding improvements. Opportunity for flexible office-based or remote work, with strong focus on PHI privacy and

Qualifications

• Associate's or bachelor’s degree in health information management or related field.
• Certified Coding Specialist (CCS) certification required.
• 2-3 years’ experience in DRG validation, inpatient medical coding, or related coding review.
• Strong understanding of ICD-10-CM/PCS coding guidelines, DRG reimbursement methodology, and hospital billing processes.

Responsibilities

• Review inpatient claims imported into the DRG database, focusing on diagnosis, procedures, grouping logic, and reimbursement accuracy.
• Analyze weekly hospital billing files, identifying underpaid claims based on ICD-10 diagnosis and procedure codes.
• Conduct detailed medical record reviews post-bill to determine if submitted diagnosis and procedure codes are accurate and complete.
• Navigate medical records efficiently, targeting specific sections based on system edits and flagged items.
• Match clinical documentation in the medical record to corresponding ICD-10 codes, ensuring DRG accuracy.
• Identify and correct errors such as under coded or misclassified diagnoses and procedures.
• Utilize Health ROI system edits to detect high-value opportunities.
• Make reimbursement improvement recommendations and submit findings for client review and approval.
• Collaborate with leadership on case prioritization and workflow management.
• Stay informed on coding updates, payer guidelines, and DRG changes to support accurate recommendations.
• Analyze client reporting.
• Identify new revenue opportunities related to all inpatient DRG components.

Skills

ICD-10 coding

DRG validation

Analytical thinking

EMRs proficiency

Education

Associate's or Bachelor's degree in health information management

RHIT or RHIA credential encouraged

Tools

DRG software

Billing databases

Job description

EnableComp is seeking a DRG Auditor to review post-billed inpatient claims, validate missed reimbursement opportunities, and optimize hospital reimbursement. The role requires ICD-10 coding expertise and CCS certification, with experience in DRG validation and post-bill coding.

Responsibilities include analyzing inpatient claims, conducting medical record reviews, and identifying DRG coding improvements. Opportunity for flexible office-based or remote work, with strong focus on PHI privacy and