DRG & ICD-10 Auditor – Revenue Integrity Expert

enablecomp; United States; Remote; USD 70,000 - 100,000; Full time

Job summary

EnableComp provides Specialty Revenue Cycle Management solutions for healthcare organizations. We are seeking a DRG Auditor to review post-billed inpatient claims and identify missed reimbursement opportunities using ICD-10 coding within a DRG database.

You will analyze coding accuracy, recommend improvements, and ensure compliance while handling PHI with the utmost privacy. This remote role supports hospitals and health systems nationwide.

Qualifications

• Requires associate's or bachelor's degree in health information management.
• CCS certification required.
• 2-3 years' DRG validation or inpatient coding experience.
• Strong knowledge of ICD-10-CM/PCS and DRG reimbursement.

Responsibilities

• Review inpatient claims imported into the DRG database, focusing on diagnosis, procedures, grouping logic, and reimbursement accuracy.
• Analyze weekly hospital billing files, identifying underpaid claims based on ICD-10 diagnosis and procedure codes.
• Conduct detailed medical record reviews post-bill to determine if submitted diagnosis and procedure codes are accurate and complete.
• Navigate medical records efficiently, targeting specific sections based on system edits and flagged items.
• Match clinical documentation in the medical record to corresponding ICD-10 codes, ensuring DRG accuracy.
• Identify and correct errors such as under coded or misclassified diagnoses and procedures.
• Utilize Health ROI system edits to detect specific high-value opportunities.
• Make reimbursement improvement recommendations and submit findings for client review and approval.
• Collaborate with leadership on case prioritization and workflow management.
• Stay informed on coding updates, payer guidelines, and DRG changes to support accurate recommendations.
• Analyze client reporting.
• Identify new revenue opportunities related to all inpatient DRG related components.
• Other duties as required.

Skills

ICD-10 coding

DRG review

Analytical thinking

Documentation accuracy

Education

Associate's or Bachelor's degree in Health Information Management

Certified Coding Specialist (CCS)

Tools

EMR systems

Microsoft Office

Job description

EnableComp provides Specialty Revenue Cycle Management solutions for healthcare organizations. We are seeking a DRG Auditor to review post-billed inpatient claims and identify missed reimbursement opportunities using ICD-10 coding within a DRG database.

You will analyze coding accuracy, recommend improvements, and ensure compliance while handling PHI with the utmost privacy. This remote role supports hospitals and health systems nationwide.