DRG Auditor

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

Job summary

An established industry player is looking for a skilled DRG Validation Auditor to join their remote team. This role is ideal for someone with extensive inpatient nursing and coding experience, who is ready to ensure coding accuracy and generate high-quality claims. Responsibilities include performing medical audits and using proprietary systems to maintain high standards of quality. The position offers a full-time opportunity with competitive benefits, making it perfect for those looking to advance their career in a supportive and dynamic environment.

Benefits

Medical Insurance

Vision Insurance

401(k) Plan

Qualifications

• 5-7+ years of experience in coding and reimbursement policies.
• Expertise in DRG & ICD-10 coding essential for the role.

Responsibilities

• Perform medical audits integrating coding principles and clinical guidelines.
• Generate audit reports and ensure coding accuracy.

Skills

ICD-9/10CM

MS-DRG

AP-DRG

APR-DRG

Clinical Documentation

Inpatient Nursing

Education

Registered Nurse (RN)

Degree in RHIM, RHIA, RHIT

Medical Coding Certification

Tools

Proprietary Auditing Systems

Job description

Job Description

Insight Global is seeking a DRG Validation Auditor for a remote position. The ideal candidate will have 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 and generating high-quality claims, performing clinical reviews, and ensuring coding accuracy.

Responsibilities

1. Perform medical audits integrating coding principles, clinical guidelines, and industry knowledge independently.
2. Use proprietary auditing systems proficiently to make determinations and generate audit reports.
3. Meet production goals and maintain high accuracy and quality standards.
4. Identify additional recoveries and suggest process improvements.

Qualifications

Must Haves:

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

Additional Details

Position is full-time, mid-senior level, and remote. Benefits include medical insurance, vision insurance, and 401(k). The role focuses on general business within staffing and recruiting industries.