DRG Auditor

Insight Global; United States; On-site; USD 86,000 - 105,000; Full time

Job summary

Insight Global is seeking experienced DRG Validation Auditors to support a leading healthcare analytics organization. This role is ideal for professionals with a strong background in inpatient coding, clinical documentation improvement, DRG validation, and healthcare auditing who thrive in a production-driven environment.

This position is responsible for auditing inpatient medical records, validating DRG assignments, identifying coding inaccuracies, and generating recoverable claims.

Qualifications

• Current experience performing DRG validation audits or DRG auditing.
• Strong inpatient healthcare experience.
• Experience reviewing medical records and clinical documentation.
• Knowledge of ICD-9, ICD-10, and DRG methodologies.
• Experience working in a metrics-driven environment.

Responsibilities

• Review inpatient medical records to validate coding accuracy and DRG assignment.
• Apply advanced ICD-10 coding knowledge and clinical guidelines during audit review.
• Audit claims related to MS-DRG, AP-DRG, and APR-DRG payment methodologies.
• Identify coding discrepancies and reimbursement opportunities.
• Generate detailed audit findings and supporting documentation.
• Utilize proprietary audit systems to document determinations and prepare audit letters.
• Meet established productivity, accuracy, and quality metrics.
• Recommend process improvements and identify additional recovery opportunities.

Skills

DRG validation audits

Inpatient coding

Clinical documentation

DRG methodologies

Healthcare auditing

Education

BSN, RN, or LPN

CCS

CCDS

CDIP

CPC

RHIA

RHIT

Job description

Compensation: $95,000 annualized ($45.67/hour) + Overtime (1.5x pay) + Weekly Performance Bonuses ($200-$400)

Schedule: Monday-Friday, 9:00 AM-5:00 PM in your local time zone

Training: First 4 weeks will be conducted 9:00 AM-5:00 PM EST

About the Opportunity

Insight Global is seeking experienced DRG Validation Auditors to support a leading healthcare analytics organization. This role is ideal for professionals with a strong background in inpatient coding, clinical documentation improvement, DRG validation, and healthcare auditing who thrive in a production-driven environment.

This position is responsible for auditing inpatient medical records, validating DRG assignments, identifying coding inaccuracies, and generating recoverable claims. Candidates must possess hands‑on DRG audit experience and a deep understanding of inpatient reimbursement methodologies.

What You'll Do

• Review inpatient medical records to validate coding accuracy and DRG assignment.
• Apply advanced ICD-10 coding knowledge and clinical guidelines during audit review.
• Audit claims related to MS-DRG, AP-DRG, and APR-DRG payment methodologies.
• Identify coding discrepancies and reimbursement opportunities.
• Generate detailed audit findings and supporting documentation.
• Utilize proprietary audit systems to document determinations and prepare audit letters.
• Meet established productivity, accuracy, and quality metrics.
• Recommend process improvements and identify additional recovery opportunities.

Required Qualifications

All Candidates Must Have:

• Current experience performing DRG validation audits or DRG auditing
• Strong inpatient healthcare experience
• Experience reviewing medical records and clinical documentation
• Knowledge of ICD-9, ICD-10, and DRG methodologies
• Experience working in a metrics-driven environment

Must have:

• BSN, RN, or LPN
• One of the following certifications:
• CCS
• CCDS
• CDIP
• CPC
• 2+ years of DRG audit experience

Must have:

• RHIA or RHIT
• One of the following certifications:
• CCS
• CCDS
• CDIP
• CPC
• 5+ years of DRG audit experience

No Degree Pathway

Must have:

• CCS, CCDS, CDIP, or CPC Certification
• 7+ years of DRG audit experience

Candidates Will Not Be Considered If Their Recent Experience Is Primarily In:

• HCC Coding
• Case Management

Preferred Backgrounds

• DRG Validation Auditor
• Clinical Documentation Improvement Specialist (CDI)