DRG Auditor

Insight Global; United States; Remote; USD 95,000; Full time

Job summary

A leading company is seeking a DRG Validation Auditor for a fully remote role. The position involves auditing inpatient medical records to ensure accurate coding and DRG assignment, focusing on reimbursement guidelines. Ideal candidates will have extensive experience in coding and clinical documentation, with a nursing background or relevant degree.

Benefits

Medical insurance

Vision insurance

401(k)

Qualifications

• 5-7+ years experience with coding and DRG systems.
• Inpatient experience and coding/clinical documentation certification.

Responsibilities

• Perform clinical reviews of medical records for coding accuracy.
• Utilize proprietary auditing systems for determinations.
• Identify claims with potential recoveries and suggest improvements.

Skills

ICD-9/10CM

DRG & ICD-10 coding

Medical claims billing

Provider guidelines

Payer reimbursement policies

Education

Registered Nurse (RN)

RHIM

RHIA

RHIT

Job description

Job Title: DRG Validation Auditor (Remote)

Insight Global is seeking a DRG Validation Auditor for a fully remote position. The role involves auditing inpatient medical records to ensure accurate coding and DRG assignment, with a focus on reimbursement guidelines such as MS-DRG, AP-DRG, and APR-DRG systems.

Must Haves:

• 5-7+ years of experience with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG, including knowledge of medical claims billing, provider guidelines, payer reimbursement policies, and coding terminology.
• Expertise in DRG & ICD-10 coding.
• Registered Nurse (RN) with inpatient experience and coding/clinical documentation certification (minimum 2 years).
• Alternatively, a degree in RHIM, RHIA, or RHIT with a medical coding credential.

Day-to-Day Responsibilities:

• Perform clinical reviews of medical records to evaluate coding accuracy and DRG assignment.
• Utilize proprietary auditing systems to make determinations and generate audit letters.
• Maintain production goals and ensure high-quality, accurate audits.
• Identify claims with potential recoveries and suggest process improvements.

Additional Details:

• Seniority level: Mid-Senior level
• Employment type: Full-time
• Job function: Analyst
• Industry: Staffing and Recruiting

Benefits include medical insurance, vision insurance, and 401(k). This position offers a salary range of approximately $95,000 annually, paid hourly at $45.67/hour, with potential bonuses of $200-$400 weekly.