DRG Auditor: ICD-10 Coding & Reimbursement Expert

Socket.dev; Franklin (TN); Remote; USD 65,000 - 90,000; Full time

Job summary

EnableComp is seeking a DRG Auditor to review post-billed inpatient claims, validate MIS codes, and optimize hospital reimbursement. You will work with a DRG database, apply ICD-10 coding knowledge, and ensure accuracy in documenting diagnoses and procedures.

Certification as CCS is required, with emphasis on DRG guidelines and PHI handling. The role may be remote or office-based, with exposure to high-volume data and collaboration with leadership on prioritization and reporting.

Qualifications

• Associate's or bachelor’s degree in health information management or related field required.
• RHIT or RHIA credentialed individuals encouraged.

Responsibilities

• Review inpatient claims in DRG database to ensure accurate diagnosis and procedure coding.
• Analyze weekly hospital billing files to identify underpaid claims.
• Perform detailed post-bill medical record reviews for coding accuracy.
• Match clinical documentation to ICD-10 codes to ensure DRG accuracy.
• Identify and correct undercoded or misclassified diagnoses and procedures.
• Provide reimbursement improvement recommendations and client-facing reports.

Skills

ICD-10 coding

Analytical thinking

Detail-oriented

Communication skills

Education

Associate or bachelor's degree in health information management

RHIT or RHIA encouraged

Tools

DRG software

EMR systems

Job description

EnableComp is seeking a DRG Auditor to review post-billed inpatient claims, validate MIS codes, and optimize hospital reimbursement. You will work with a DRG database, apply ICD-10 coding knowledge, and ensure accuracy in documenting diagnoses and procedures.

Certification as CCS is required, with emphasis on DRG guidelines and PHI handling. The role may be remote or office-based, with exposure to high-volume data and collaboration with leadership on prioritization and reporting.