DRG Auditor | Inpatient Coding Quality & Compliance

Insightful Talent, LLC; United States; On-site; USD 65,000 - 90,000; Full time

Job summary

Insightful Talent, LLC is seeking a DRG Auditor to review inpatient medical records for coding accuracy, completeness, and compliance with ICD-10-CM/PCS and, when applicable, CPT/HCPCS. The auditor will evaluate documented diagnoses, procedures, and services against guidelines and payer requirements, identify coding errors, and explain recommended corrections.

You will collaborate with coding teams, healthcare providers, and billing partners to resolve issues, strengthen documentation, and

Qualifications

• At least two years of hospital inpatient coding experience.
• Proficiency in assigning ICD-10 diagnosis and procedure codes.
• Experience with Diagnosis-Related Group (DRG) assignment.
• Ability to identify documented coexisting conditions and complications that may affect patient care and DRG assignment.
• Ability to maintain a production volume of 25 or more coded charts per day.

Responsibilities

• Clearly explain why a code is incorrect, identify the appropriate code, and document the rationale for the change.
• Identify documented conditions or complications that may affect DRG assignment.
• Apply commercial and government payer rules that affect coding assignment.
• Understand medical-necessity guidelines and the documentation required to support them.
• Recognize when a provider query or record amendment may be needed to clarify documentation and support accurate code assignment.
• Distinguish authoritative coding guidance from non-authoritative or opinion-based resources.

Skills

ICD-10 coding

DRG assignment

Inpatient coding

Medical necessity knowledge

Time management

Job description

Insightful Talent, LLC is seeking a DRG Auditor to review inpatient medical records for coding accuracy, completeness, and compliance with ICD-10-CM/PCS and, when applicable, CPT/HCPCS. The auditor will evaluate documented diagnoses, procedures, and services against guidelines and payer requirements, identify coding errors, and explain recommended corrections.

You will collaborate with coding teams, healthcare providers, and billing partners to resolve issues, strengthen documentation, and