Diagnostic Related Group (DRG) Validation Auditor

Second Wave Delivery Systems, LLC; Las Vegas (NV); On-site; USD 90,000 - 130,000; Full time

Benefits offered by this job

Health insurance

Vision insurance

Life insurance

Paid time off

Job summary

Secondwave seeks a DRG Validation Auditor to partner with a Medical Director in inpatient documentation reviews. You will validate diagnoses and procedures, update coding for compliant reimbursement, and ensure data integrity across client systems.

Ideal candidates have inpatient coding experience (3+ years), MS-DRG/APR-DRG knowledge, and AHIMA/AAPC credentials. This remote role supports HIPAA-compliant workflows and ongoing training.

Qualifications

• Active coding certification in AHIMA or AAPC (RHIA, RHIT, CCS, CPC, CIC)
• Strong knowledge of MS-DRG and APR-DRG reimbursement methodologies
• Expert understanding of ICD-10-CM/PCS coding guidelines and auditing principles

Responsibilities

• Conduct pre-bill reviews with physicians to confirm accurate diagnosis and procedure coding for inpatient encounters
• Utilize client systems to track coding changes and capture audit data
• Investigate and resolve coding compliance issues and client denials
• Maintain high accuracy and productivity while adhering to coding recommendations
• Communicate with physicians and CDI teams regarding documentation and compliance requirements
• Provide input on process improvements to enhance operational efficiency and financial accuracy
• Deliver education and training sessions on coding best practices and regulatory updates
• Stay current with coding changes and HIPAA regulations
• Ensure confidentiality of patient records and HIPAA compliance

Skills

MS-DRG

APR-DRG

ICD-10-CM/PCS

EMR systems

HIPAA compliance

Communication

Education

AHIMA/AAPC certification

Associate’s degree in Health Information Management

High School Diploma or GED

Tools

EPIC

Job description

As a key member of Secondwave’s Inpatient documentation review team, the Diagnostic Related Group (DRG) DRG Validation Auditor partners with a Medical Director (Physician) in tandem to ensure accurate and compliant DRG assignment through secondary review of inpatient medical records. This role involves validating diagnosis and procedure codes and updating coding as needed in alignment with federal regulations, official coding guidelines, and client-specific standards which result in appropriate reimbursement and data integrity. The position requires strong analytical skills, deep knowledge of DRG methodologies, and a commitment to supporting appropriate reimbursement and data integrity.

Primary Responsibilities

Conduct detailed pre-bill reviews in collaboration with physicians to confirm accurate diagnosis and procedure coding for inpatient encounters

Utilize proprietary technology and client systems to track coding changes, identify query opportunities, and capture audit data

Investigate and resolve coding compliance issues, inappropriate coding, and client denials

Maintain high accuracy and productivity standards while meeting organizational coding recommendations

Communicate effectively with physicians, CDI specialists, and internal teams regarding documentation and compliance requirements

Provide input on process improvements to enhance operational efficiency and financial accuracy

Develop and adapt client-specific protocols to align with organizational methodology

Deliver group education and training sessions on coding best practices and regulatory updates

Participate in ongoing training to stay current with coding changes and compliance regulations

Ensure confidentiality of patient records and adhere to HIPAA standards

Perform additional coding tasks as needed based on organizational priorities

Position Qualifications

Education:

High School Diploma or GED required

Associate’s degree in Health Information Management or related field preferred

Experience:

Minimum 3 years of inpatient hospital coding experience

Minimum 2 years in a role involving DRG validation and compliance review

Strong knowledge of MS-DRG and APR-DRG reimbursement methodologies

Credentials:

Active coding certification from AHIMA or AAPC (RHIA, RHIT, CCS, CPC, CIC)

Knowledge, Skills, and Abilities:

Expert understanding of ICD-10-CM/PCS coding guidelines and auditing principles

Ability to interpret complex documentation and apply compliant coding updates

Advanced proficiency in EMR systems and coding software; EPIC experience preferred

Strong analytical and critical thinking skills for problem-solving and compliance review

Excellent communication and interpersonal skills for collaboration with physicians and CDI teams

Knowledge of regulatory requirements and policy compliance related to coding and documentation

Ability to maintain confidentiality and exercise independent judgment

Proficiency in Microsoft Office Suite (Word, Excel, Teams)

Self-directed and adaptable to remote or on-site work environments

• Health insurance
• Vision insurance
• Life insurance
• Paid time off

Location

• Remote