DRG Auditor

Insight Global; United States; Remote; Full time

Job summary

A leading healthcare company is seeking a DRG Validation Auditor for a remote position. The ideal candidate will have extensive experience in clinical documentation and inpatient coding, with a strong understanding of reimbursement guidelines. Responsibilities include auditing medical records, ensuring coding accuracy, and generating high-quality claims. The role requires a Registered Nurse with coding certification or a degree in health information management. Join a dynamic team and contribute to improving healthcare processes.

Benefits

Medical insurance

Vision insurance

401(k)

Qualifications

• 5-7+ years of experience with ICD-9/10CM and medical claims billing.
• Registered Nurse with coding/clinical documentation certification.

Responsibilities

• Auditing inpatient medical records and generating recoverable claims.
• Applying medical coding principles and maintaining production goals.
• Identifying claims for additional recoveries.

Skills

ICD-9/10CM

MS-DRG

AP-DRG

APR-DRG

medical claims billing

coding terminology

clinical documentation

Education

Registered Nurse (RN)

RHIM

RHIA

RHIT

CCS

Job description

2 weeks ago Be among the first 25 applicants

Salary: 95K (paid hourly - 45.67/hour) with opportunity for $200-$400 bonuses weekly

Interview Process:

1. Recruiter will identify and screen candidate and fill out the questionnaire below
2. Assignment: 60 true/false & multiple choice questions, with a 2-hour completion window
3. 1 round interview with hiring manager

Must Haves

• 5-7+ years of experience with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG, with broad knowledge of medical claims billing/payment systems, provider billing guidelines, payer reimbursement policies, medical necessity criteria, and coding terminology
• Expertise in coding (DRG & ICD-10)
• Registered Nurse (RN) with inpatient experience AND coding/clinical documentation certification (minimum 2 years in clinical documentation)

OR

Degree in RHIM, RHIA, RHIT with medical coding certification or CCS, with strong clinical knowledge

Day-to-Day Responsibilities

Insight Global is seeking a DRG Validation Auditor for a remote position. The candidate should have extensive experience in facility-based nursing, clinical documentation, and/or inpatient coding, with a strong understanding of reimbursement guidelines, particularly MS-DRG, AP-DRG, and APR-DRG systems. Responsibilities include auditing inpatient medical records and generating high-quality recoverable claims, performing clinical reviews, and evaluating coding accuracy. Key duties include:

• Applying medical coding principles, clinical guidelines, and objectivity in audit activities. Utilizing advanced ICD-10 coding expertise to substantiate conclusions. Working independently.
• Using proprietary auditing systems proficiently to make audit determinations and generate audit letters.
• Maintaining production goals set by management.
• Achieving accuracy and quality standards for valid claim identification and documentation.
• Identifying potential claims for additional recoveries and suggesting process improvements.

Additional Details

• Seniority level: Mid-Senior level
• Employment type: Full-time
• Job function: Information Technology
• Industries: Hospitals and Healthcare

Referrals increase your chances of interviewing at Insight Global by 2x.

Benefits Inferred

Medical insurance, Vision insurance, 401(k)

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