DRG Revenue Integrity Auditor - REMOTE

CorroHealth

United States

On-site

USD 60,000 - 80,000

Full time

14 days+

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Benefits offered by this job

Medical, Dental, Vision coverage

401K with match

Long-term disability insurance

Work-life balance with a predictable schedule

Job summary

CorroHealth is seeking a DRG Revenue Integrity Auditor to perform audits, ensure coding accuracy, and provide training. The role demands strong analytical skills and adherence to coding guidelines, contributing to quality assurance in patient care. Join a team dedicated to professional growth with a full-time remote working environment.

Qualifications

5+ years in acute care as a DRG Auditor or Clinical Documentation Specialist.
CCS certification mandatory.
Experience with telecommuting and EMR systems required.

Responsibilities

Conduct DRG validation and quality audits on inpatient charts.
Analyze records for coding accuracy and potential query opportunities.
Provide training to new hires and assist with project data analysis.

Skills

Analytical Skills

Communication Skills

Teamwork

Attention to Detail

Education

CCS Certification

Tools

MS Word

MS Excel

MS Outlook

Teams

Job description

Join to apply for the DRG Revenue Integrity Auditor role at CorroHealth

About Us

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals.

We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.

Job Summary

The DRG Revenue Integrity Auditor (DRG - A) performs Diagnostic Related Group (DRG) validation and quality audits on Inpatient charts. The DRG - A will perform chart reviews and will ensure that all reviewed charts capture the patient’s true clinical picture from the codes assigned by the facility’s coders in compliance with federal laws. The DRG - A will utilize International Classification of Diseases - Clinical Modification (CM) and Procedure Coding System (PCS) Terminology to ensure accurate coding. Responsible for validating proper sequencing and accuracy of ICD-10-CM/PCS codes, POA assignments, severity of illness (SOI), risk of mortality (ROM), Hierarchical Condition Category (HCC) capture CMI and other coding factors. Usage of most current Clinical Criteria, MCG, InterQual, payers’ Clinical Policy Bulletins, CMS Guidelines, NCDs and/or LCDs. Adherence to all coding guidelines and CDI best practices, as endorsed by ACDIS and AHIMA, to determine correct coding that is clinically supported and composing and sending queries when necessary. Analyze records for potential query opportunities and appropriate code assignment along with correct code sequencing. Maintain quality of reviews by making sure the true clinical picture is captured timely. Staying up to date with medical and coding guidelines, along with advancements within their field. Support CorroHealth in developing accurate training materials. Provide training and shadowing to new hires. Assist CorroHealth with project data analysis, reporting, and feedback internally and externally to CorroHealth clients. Maintain professional etiquette. Ensures all PHI is appropriately stored and delivered to authorized individuals. Meets or exceeds production and quality metrics. Attend all mandatory meetings and trainings. Additionally, DRG - A may also be required to audit clients’ clinical documentation integrity (CDI) program to include query review, analysis of coding, and overall program accuracy. Responsible to keep up with your company and EMR access log ins and passwords. All other position related duties as delegated by management. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The list below is representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

**Sign on bonus available**

Essential Duties And Responsibilities

Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.

Important Duties And Responsibilities

Adherence to all coding guidelines and CDI best practices, as endorsed by ACDIS and AHIMA, to determine correct coding that is clinically supported
Analyze records for potential query opportunities and appropriate code assignment and code sequencing
Maintain quality of reviews and making sure the true clinical picture is captured, along with ensuring chart review productivity
Staying up to date with official coding guidelines, coding clinics and clinical criteria
Available to provide training to other new hires, if required, along with supporting development of training materials, as well as clinical, coding and CDI policies
Assisting with project data analysis, reporting, and feedback both internally and to clients
In all situations, protecting the privacy and confidentiality of patient health and client information, and follows the Standards of Ethical Coding as set forth by AHIMA and adheres to official coding guidelines and compliance practices, standards, and procedures
Conduct chart reviews as assigned, meeting the productivity standards as set forth for each project or record type
Communicates with coworkers in an open and respectful manner that promotes teamwork and knowledge sharing
When interacting with clients, always conducts themselves in a professional manner, exhibiting excellent relationship, work performance and communication skill so as to support the company and its business interests
Maintenance of professional credentials and knowledge of CDI, coding, reimbursement, and compliance issues through continuing education
Other duties and responsibilities, as assigned

Work Experience

CCS Required
Five or more years working in an acute care setting or a third-party vendor as a DRG Auditor or Clinical Documentation Specialist (CDS).
Prior experience of working as a CDI/Coding auditor is preferred but NOT a requirement.

Knowledge, Skills & Abilities

Experience with telecommuting and electronic medical record systems required
Good computer skills and familiarity with commonly used work apps, such as MS Word, MS Excel, MS Outlook, Teams, etc.
Strong analytical skills
Works well with numbers, using basic math skills
Strong team player
Ability to work with multiple and diverse clients and projects
Ability to switch between multiple clients throughout the day and week
Ability to work with minimal supervision
Ability to maintain and access multiple files

We Offer

Quality of life with a remote predictable, full-time schedule
Exempt/Salaried positions
Opportunities for career growth within the organization
Medical, Dental, Vision coverage, 401K with match
Long-term disability insurance, life insurance and more
Holidays Time and ample paid time off
Allowance for CME and/or license renewal

Physical Demands

Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.

A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.

Seniority level