DRG Revenue Integrity Auditor

ISHE; United States; Remote; USD 75,000 - 95,000; Full time

Benefits offered by this job

Sign on bonus available

Job summary

CorroHealth is hiring a DRG Revenue Integrity Auditor to validate inpatient DRGs, ensure precise ICD-10-CM/PCS coding, and assess documentation quality. You will review POA indicators, SOI, ROM, and HCC capture while using CMS, MCG, InterQual, and LCDs as references.

The role supports training and audits, with telecommuting options and ongoing professional development. Ideal candidates have 5+ years in acute care or with a third-party vendor, CCS certification, and strong analytical and

Qualifications

• Five or more years working in an acute care setting or a third-party vendor as a DRG Auditor or CDS.
• CCS required, CCDS or CDIP a plus.

Responsibilities

• Perform detailed DRG validation reviews of inpatient charts.
• Ensure ICD-10-CM/PCS codes reflect patient condition and treatment.
• Validate sequencing and accuracy of diagnoses and procedures.
• Review POA indicators, SOI, ROM, CMI, HCC capture and other coding factors.
• Utilize coding references and clinical criteria (ICD-10-CM/PCS, CMS Guidelines, MCG, InterQual).
• Adhere to AHIMA/ACDIS CDI guidelines and identify documentation gaps.
• Mentor and support new team members and participate in audits.

Skills

Analytical skills

Team player

Multi-client work

MS Office suite

Numerical skills

Work with minimal supervision

File management

Telecommuting experience

Tools

EMR software

Job description

Join a Team of Industry-Leading Experts and Help Shape the Future of Revenue Integrity
Are you a passionate coding and revenue integrity professional who thrives on clinical accuracy, continuous learning, and making a meaningful impact? At CorroHealth, you'll work alongside some of the nation's most respected physicians, clinical leaders, coding experts, and healthcare innovators to ensure the highest standards of coding accuracy and revenue integrity for leading healthcare organizations.
As a global healthcare solutions company, we invest in our people through continued education, career advancement opportunities, mentorship from industry experts, and a flexible work environment that supports work-life balance. If you're looking for an opportunity to elevate your expertise while partnering with exceptional clients and colleagues, we'd love to hear from you.
Sign on bonus available

What You'll Do

The DRG Revenue Integrity Auditor (DRG-A) performs comprehensive Diagnostic Related Group (DRG) validation and quality audits on inpatient medical records to ensure accurate representation of each patient's clinical story.

In this role, you will:

• Perform detailed DRG validation reviews of inpatient charts.
• Ensure assigned ICD-10-CM/PCS codes accurately reflect the patient's clinical condition and treatment.
• Validate proper sequencing and accuracy of diagnoses and procedures.
• Review and assess:
  
  • Present on Admission (POA) indicators
  • Severity of Illness (SOI)
  • Risk of Mortality (ROM)
  • Case Mix Index (CMI)
  • Hierarchical Condition Category (HCC) capture
  • Other coding and reimbursement factors
• Utilize current coding references and clinical criteria including:
  
  • ICD-10-CM/PCS
  • CMS Guidelines
  • MCG
  • InterQual
  • National Coverage Determinations (NCDs)
  • Local Coverage Determinations (LCDs)
  • Payer clinical policy guidelines
• Adhere to coding guidelines and CDI best practices endorsed by AHIMA and ACDIS.
• Identify documentation gaps and formulate compliant physician queries when appropriate.
• Analyze records for coding opportunities, sequencing accuracy, and clinical support.
• Maintain high-quality review standards while meeting productivity and quality expectations.
• Stay current with regulatory, coding, reimbursement, and clinical documentation updates.
• Support development of training content and educational resources.
• Mentor and provide shadowing opportunities for new team members.
• Assist with project analysis, reporting, and client-facing feedback initiatives.
• Participate in internal and external audits of Clinical Documentation Integrity (CDI) programs.
• Protect patient privacy and ensure proper handling of all PHI in accordance with company policies and regulatory requirements.
• Attend required meetings, training sessions, and educational programs.
• Perform other duties as assigned.
  

Why CorroHealth?

At CorroHealth, our people are our greatest asset. We foster a culture where healthcare professionals can grow, collaborate, and make a real impact.

Work Experience:

• Five or more years working in an acute care setting or a third-party vendor as a DRG Auditor or Clinical Documentation Specialist (CDS).
• CCS required, CCDS or CDIP a plus
  

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