DRG Auditor | ICD-10 Coding & Reimbursement Specialist

Medium; Franklin (TN); Hybrid; USD 65,000 - 90,000; Full time

Job summary

EnableComp is seeking a DRG Auditor to review post-billed inpatient claims, identify missed reimbursement opportunities, and validate ICD-10 coding within a specialized DRG database. The role requires CCS certification and a deep understanding of medical record documentation, DRG reimbursement methodology, and hospital billing processes.

You will analyze records, correct under-coded or misclassified codes, collaborate with leadership, and ensure compliance while protecting PHI.

Qualifications

• Requires Associate's or Bachelor's in health information management or related field.
• CCS certification required.
• 2-3 years’ DRG validation or inpatient medical coding experience.
• Strong knowledge of ICD-10-CM/PCS coding guidelines and DRG reimbursement.
• Experience reading clinical documentation across departments.

Responsibilities

• Review inpatient claims in DRG database for diagnosis, procedures, grouping logic and reimbursement accuracy.
• Analyze weekly hospital billing files to identify underpaid claims by ICD-10 codes.
• Conduct post-bill medical record reviews to verify codes are accurate and complete.
• Match documentation to ICD-10 codes ensuring DRG accuracy and identify errors.
• Make reimbursement improvement recommendations and present findings to clients.

Skills

Analytical thinking

Detail-oriented

Strong communication

Education

Health information management degree

RHIT or RHIA credential encouraged

Tools

DRG software

EMRs

Billing databases

Health ROI system

Job description

EnableComp is seeking a DRG Auditor to review post-billed inpatient claims, identify missed reimbursement opportunities, and validate ICD-10 coding within a specialized DRG database. The role requires CCS certification and a deep understanding of medical record documentation, DRG reimbursement methodology, and hospital billing processes.

You will analyze records, correct under-coded or misclassified codes, collaborate with leadership, and ensure compliance while protecting PHI.