DRG Inpatient Auditor

Insight Global; United States; Remote; USD 85,000 - 92,000; Full time

Job summary

A leading company is seeking a DRG Validation Auditor for a remote position. The ideal candidate will have extensive experience in inpatient coding and clinical documentation, ensuring accurate coding and DRG assignment. Responsibilities include auditing medical records and generating recoverable claims. This full-time role requires a strong understanding of reimbursement guidelines and coding systems.

Qualifications

• 5-7+ years of experience with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG.
• Registered Nurse (RN) with inpatient experience.

Responsibilities

• Performing clinical reviews of medical records to evaluate coding accuracy.
• Using proprietary auditing systems to determine audit outcomes.

Skills

ICD-9/10CM

DRG & ICD-10 coding

Clinical documentation

Education

Degree in RHIM, RHIA, RHIT

Clinical documentation certification

Job description

Job Description

Insight Global is seeking a DRG Validation Auditor for a remote position. The ideal candidate will have extensive experience in inpatient coding, clinical documentation, or facility-based nursing, with a strong understanding of reimbursement guidelines, MS-DRG, AP-DRG, and APR-DRG payment systems. The role involves auditing inpatient medical records to ensure accurate coding and DRG assignment, and generating high-quality recoverable claims.

Responsibilities include:

1. Performing clinical reviews of medical records and documentation to evaluate coding accuracy.
2. Using proprietary auditing systems proficiently to determine audit outcomes and generate reports.
3. Maintaining productivity and accuracy standards.
4. Identifying claims with potential recoveries and suggesting process improvements.

Minimum Qualifications

• 5-7+ years of experience with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG.
• Expertise in DRG & ICD-10 coding.
• Registered Nurse (RN) with inpatient experience and clinical documentation certification, or
• Degree in RHIM, RHIA, RHIT with medical coding certification or CCS, along with clinical knowledge.

Additional Details

Salary range: $85,000 - $92,000, based on experience.

Employment type: Full-time, Mid-Senior level.

Industry: Staffing and Recruiting.