DRG Auditor

Insight Global; United States; Remote; USD 60,000 - 100,000; Full time

Job summary

An established industry player in healthcare is seeking a DRG Validation Auditor for a remote position. This role is ideal for a seasoned professional with extensive experience in inpatient nursing and coding, who can ensure coding accuracy and generate recoverable claims. The successful candidate will conduct medical audits, improve audit processes, and utilize proprietary systems to communicate findings effectively. This is a fantastic opportunity to contribute to a vital sector while working from the comfort of your home. Join a team dedicated to excellence in healthcare auditing and make a significant impact in the industry.

Qualifications

• 5-7+ years of experience in inpatient coding and clinical documentation.
• Strong understanding of reimbursement guidelines and payment systems.

Responsibilities

• Perform medical audits using coding principles and clinical guidelines.
• Utilize auditing systems to communicate findings and meet accuracy goals.

Skills

ICD-9/10CM

MS-DRG

AP-DRG

APR-DRG

Clinical Documentation

Inpatient Nursing

Education

Registered Nurse (RN)

Degree in RHIM

Degree in RHIA

Degree in RHIT

Certification in CCS

Tools

Proprietary Auditing Systems

Job description

Job Description: DRG Validation Auditor

Insight Global is seeking a DRG Validation Auditor for a remote position. The ideal candidate has extensive experience in inpatient nursing, clinical documentation, or inpatient coding, with a strong understanding of reimbursement guidelines, MS-DRG, AP-DRG, and APR-DRG payment systems. The role involves auditing inpatient medical records to ensure coding accuracy and generate recoverable claims, performing clinical reviews, and improving audit processes.

Responsibilities include:

1. Performing medical audits using coding principles, clinical guidelines, and industry standards.
2. Utilizing proprietary auditing systems to make determinations and communicate findings.
3. Meeting production and accuracy goals set by management.
4. Identifying additional recoveries and suggesting process improvements.

Qualifications:

• 5-7+ years of experience with ICD-9/10CM, MS-DRG, AP-DRG, APR-DRG, and related billing/payment systems.
• Expertise in DRG & ICD-10 coding.
• Registered Nurse (RN) with inpatient experience and coding/clinical documentation certification, or a degree in RHIM, RHIA, RHIT, or CCS with clinical knowledge.

Additional Details:

• Employment Type: Full-time, Mid-Senior level.
• Industry: Hospitals and Healthcare.