DRG Revenue Integrity Auditor

Nacba; United States; On-site; USD 75,000 - 90,000; Full time

Benefits offered by this job

Sign on bonus available

Medical, dental and vision coverage

401(k) with match

Paid time off

Job summary

NACBA is seeking a DRG Revenue Integrity Auditor in the United States to perform validation and quality audits on inpatient charts. The role focuses on ensuring compliance with coding guidelines and provides training to new hires.

This full-time position offers a predictable schedule, sign-on bonuses, and various benefits including medical coverage and opportunities for career growth.

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Qualifications

• Five or more years working in an acute care setting as a DRG Auditor or Clinical Documentation Specialist.
• Prior experience as a CDI/Coding auditor is preferred.

Responsibilities

• Perform DRG validation and quality audits on inpatient charts.
• Maintain quality of reviews and ensure the clinical picture is captured.
• Provide training to new hires and support development of training materials.

Skills

Strong analytical skills

Familiar with telecommuting

Good computer skills including MS Office

Ability to work with minimal supervision

Education

CCS certification

Tools

Electronic medical record systems

Job description

The DRG Revenue Integrity Auditor (DRG - A) performs Diagnostic Related Group (DRG) validation and quality audits on inpatient charts. The DRG - A reviews charts to 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 utilizes International Classification of Diseases – Clinical Modification (ICD‑10‑CM) and Procedure Coding System (PCS) terminology to ensure accurate coding, 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. The role uses current clinical criteria, MCG, InterQual, payers’ clinical policy bulletins, CMS guidelines, NCDs and/or LCDs, adhering to all coding guidelines and CDI best practices endorsed by ACDIS and AHIMA. The auditor analyzes records for potential query opportunities and appropriate code assignment with correct sequencing, maintains quality of reviews, stays up to date with medical and coding guidelines, supports development of accurate training materials, provides training and shadowing to new hires, assists with project data analysis, reporting, and feedback internally and externally to clients, maintains professional etiquette, ensures PHI is appropriately stored and delivered to authorized individuals, meets or exceeds production and quality metrics, attends mandatory meetings and trainings, may audit clients’ CDI programs, and keeps up with company and EMR access logs and passwords. All other position‑related duties are delegated by management. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Important Duties and Responsibilities

• Adhere to all coding guidelines and CDI best practices endorsed by ACDIS and AHIMA.
• Analyze records for potential query opportunities and appropriate code assignment and sequencing.
• Maintain quality of reviews and ensure the true clinical picture is captured, while meeting chart review productivity standards.
• Stay current with official coding guidelines, coding clinics and clinical criteria.
• Provide training to new hires, support development of training materials, and maintain clinical, coding and CDI policies.
• Assist with project data analysis, reporting, and feedback internally and to clients.
• Protect privacy and confidentiality of patient health and client information following AHIMA standards.
• Adhere to compliance practices, standards, and procedures.
• Communicate with coworkers respectfully, promoting teamwork and knowledge sharing.
• Maintain professional relationships and communication skills when interacting with clients.
• Maintain professional credentials and knowledge of CDI, coding, reimbursement, and compliance issues through continuing education.
• Perform other duties 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.
• Prior experience as a CDI/Coding auditor is preferred but not required.

Knowledge, Skills & Abilities

• Experience with telecommuting and electronic medical record systems.
• Good computer skills, familiar with MS Word, Excel, Outlook, Teams and other common work apps.
• Strong analytical skills and basic math proficiency.
• 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.

Benefits

• Sign on bonus available.
• Quality of life with a remote predictable, full‑time schedule.
• Exempt/salaried positions.
• Opportunities for career growth within the organization.
• Medical, dental and vision coverage, 401(k) with match.
• Long‑term disability insurance, life insurance and more.
• Holidays, time and ample paid time off.
• Allowance for CME and/or license renewal.