Clinical DRG Auditor- Remote

Gainwell Technologies; Texas; Remote; USD 85,000 - 95,000; Full time

Benefits offered by this job

Flexible vacation policy

401(k) employer match

Comprehensive health benefits

Educational assistance

Job summary

A healthcare solutions provider is seeking a Clinical DRG Auditor for a remote position. The role involves auditing medical records and validating DRG assignments. Candidates should have an active RN licensure, relevant coding certifications, and over 3 years of clinical hospital experience. Understanding of payment methodologies like MS-DRG is essential. The position offers a salary range of $85,000 - $95,000 annually, along with benefits including a flexible vacation policy and a 401(k).

Qualifications

• Active, unrestricted RN licensure in the United States.
• At least one relevant Coding Certification required.
• 3+ years clinical experience in an inpatient hospital setting.
• 2+ years of MS DRG/APR DRG coding or auditing experience.
• Expert knowledge of ICD-10-CM coding and DRG reimbursement methodologies.
• Demonstrated ability to apply clinical review judgment.

Responsibilities

• Perform audits of medical record documentation for coding accuracy.
• Use advanced ICD-10 coding expertise to substantiate conclusions.
• Document audit determinations using auditing systems.
• Maintain current knowledge of coding guidelines through CEUs.
• Train new Coders or Clinical DRG Auditors.

Skills

ICD-10 coding expertise

Clinical review judgment

Education

Active RN licensure

Coding Certification (RHIA, RHIT, CCS, CIC, CCDS, CPC)

Tools

Proprietary auditing systems

Job description

Clinical DRG Auditor - Remote

Date: Apr 10, 2026

Location: Any city, TX, US, 99999

Work Mode: Virtual (Exception only)

We are seeking a talented Clinical DRG Auditor who is responsible for performing DRG validation (clinical/coding) reviews of medical records and/or other documentation to validate the conditions that were documented in the medical record, the ICD-10-CM/PCS code assignments and determine the accuracy of DRG assignment that is clinically supported as defined by review methodologies specific to the contract for which review services are being provided. This involves accessing proprietary systems to audit medical records, accurately documenting findings and providing policy/regulatory support for determination. The candidate must have extensive clinical experience with a background in auditing medical records with a high level of understanding payment methodologies including MS-DRG, AP-DRG and APR-DRG.

Responsibilities

• Perform audits of medical record documentation to determine the accuracy of principal and secondary diagnosis (including MCC & CC) and procedure codes. Adhere to official coding guidelines, coding clinics and regulatory guidelines and mandates.
• Use advanced ICD-10 coding expertise and clinical knowledge to substantiate conclusions.
• Utilize HMS proprietary auditing systems with high proficiency to document audit determinations and rationale.
• Apply clinical review judgment to make coding validation determinations, including sequencing of ICD-10-CM, ICD-10-PCS procedural codes for inpatient claims.
• Consistently achieve productivity and quality performance standards established by management.
• Assist management with training new Coders or Clinical DRG Auditors, including daily monitoring, mentoring, feedback, and education.
• Maintain current knowledge of coding guidelines and complete required CEUs to maintain RN license and coding certification.
• Attend training and scheduled meetings to enhance skills and knowledge of clinical policies, procedures, rules, and regulations.

Qualifications

• Active, unrestricted RN licensure in the United States and in the state of primary home residency, or an active compact multistate unrestricted RN license.
• At least one of the following Coding Certifications required: RHIA, RHIT, CCS, CIC, CCDS or CPC.
• 3+ years clinical experience in an inpatient hospital setting.
• 2+ years of MS DRG/APR DRG coding or auditing experience with expert knowledge of ICD-10 Official Coding Guidelines and DRG reimbursement methodologies.
• Expert knowledge of ICD-10-CM coding, including principal diagnosis selection, complications/comorbidities, major complications/comorbidities, and conditions that impact severity of illness and risk of mortality.
• Expert knowledge of ICD-10-PCS coding methodologies, code sequencing, and discharge disposition in accordance with CMS requirements, official guidelines, and coding clinic guidance.
• Demonstrated ability to apply clinical review judgment to make clinical determinations.

What to Expect

• Remote work within the U.S.
• May be required to work extended hours for special business needs.
• Travel: 0–10% of the time, depending on business needs.

The pay range for this position is $85,000.00 - $95,000.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors.

All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, educational assistance, and leadership and technical development academies.

Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include all forms of pay including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.