DRG Auditor

Insightful Talent, LLC; United States; On-site; USD 65,000 - 90,000; Full time

Job summary

Insightful Talent, LLC is seeking a DRG Auditor to review inpatient medical records for coding accuracy, completeness, and compliance with ICD-10-CM/PCS and, when applicable, CPT/HCPCS. The auditor will evaluate documented diagnoses, procedures, and services against guidelines and payer requirements, identify coding errors, and explain recommended corrections.

You will collaborate with coding teams, healthcare providers, and billing partners to resolve issues, strengthen documentation, and

Qualifications

• At least two years of hospital inpatient coding experience.
• Proficiency in assigning ICD-10 diagnosis and procedure codes.
• Experience with Diagnosis-Related Group (DRG) assignment.
• Ability to identify documented coexisting conditions and complications that may affect patient care and DRG assignment.
• Ability to maintain a production volume of 25 or more coded charts per day.

Responsibilities

• Clearly explain why a code is incorrect, identify the appropriate code, and document the rationale for the change.
• Identify documented conditions or complications that may affect DRG assignment.
• Apply commercial and government payer rules that affect coding assignment.
• Understand medical-necessity guidelines and the documentation required to support them.
• Recognize when a provider query or record amendment may be needed to clarify documentation and support accurate code assignment.
• Distinguish authoritative coding guidance from non-authoritative or opinion-based resources.

Skills

ICD-10 coding

DRG assignment

Inpatient coding

Medical necessity knowledge

Time management

Job description

Insightful Talent is partnering with a RCM solutions provider in their search for a DRG Auditor. The auditor reviews inpatient medical records to assess the accuracy, completeness, and compliance of coding. This role evaluates documented diagnoses, procedures, and services against applicable coding guidelines, regulations, and payer requirements, including ICD-10-CM/PCS and, when applicable, CPT and HCPCS. The auditor identifies coding errors, discrepancies, and omissions; explains recommended corrections; and collaborates with coding teams, healthcare providers, and billing partners to resolve issues, strengthen documentation, and improve coding quality.

Auditing Responsibilities and Requirements

• Clearly explain why a code is incorrect, identify the appropriate code, and document the rationale for the change.
• Identify documented conditions or complications that may affect DRG assignment.
• Apply commercial and government payer rules that affect coding assignment.
• Understand medical-necessity guidelines and the documentation required to support them.
• Recognize when a provider query or record amendment may be needed to clarify documentation and support accurate code assignment.
• Distinguish authoritative coding guidance from non-authoritative or opinion-based resources.

Required Experience and Technical Knowledge

• At least two years of hospital inpatient coding experience.
• Proficiency in assigning ICD-10 diagnosis and procedure codes.
• Experience with Diagnosis-Related Group (DRG) assignment.
• Ability to identify documented coexisting conditions and complications that may affect patient care and DRG assignment.
• Ability to maintain a production volume of 25 or more coded charts per day.

The auditor should be familiar with inpatient coding across the following service lines:

• Surgical specialties: urology, gastroenterology, general surgery, gynecology, podiatry, neurology, spine, ENT, vascular, and ophthalmology.
• Obstetrics: deliveries, obstetric surgeries, and postpartum care in the hospital setting (not physician professional-fee coding).
• Behavioral health: inpatient behavioral medicine and psychiatric admissions.
• Medical, non-surgical inpatient cases.
• Respiratory and pulmonary conditions.
• Endocrinology.
• Cardiology, including interventional radiology procedures.

Additional Skills and Competencies

• Time management: Meet deadlines and promptly request assistance when needed to prevent turnaround-time delays.
• Attention to detail: Verify code accuracy, avoid transposed numbers, and confirm the reliability of supporting references before returning work to the client.
• Client-focused improvement: Add value through practical suggestions, education, and resource sharing that help coders strengthen their skills.
• Documentation education: Explain how physician or nursing documentation practices can be improved to support accurate code selection.

Insightful Talent LLC is an equal opportunity employer and prohibits discrimination and harassment of any kind. We provide equal employment opportunities to all employees and applicants without regard to race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age, disability, genetic information, veteran status, or any other characteristic protected by applicable laws.