DRG Revenue Integrity Auditor - REMOTE

CorroHealth Inc; Texas; À distance; USD 70 000 - 90 000; Plein temps

Résumé du poste

CorroHealth Inc is seeking a DRG Revenue Integrity Auditor (DRG-A) to perform comprehensive DRG validation and coding accuracy reviews for inpatient records in a remote role. You will ensure ICD-10-CM/PCS codes reflect the patient’s clinical condition, verify POA, SOI, ROM, and CMI, and identify documentation gaps for compliant physician queries.

The role requires adherence to AHIMA and ACDIS best practices, ongoing education, and collaboration with clinical teams to maintain high-quality CDI

Qualifications

• DRG validation and coding accuracy responsibilities.
• Ability to apply AHIMA and ACDIS guidelines to medical records.
• Experience with ICD-10-CM/PCS coding, POA indicators, and CMI calculations.

Responsabilités

• Perform comprehensive DRG validation and quality audits on inpatient records.
• Ensure ICD-10-CM/PCS codes accurately reflect diagnoses and procedures.
• Assess POA indicators, SOI, ROM, and CMI for coding accuracy.
• Identify documentation gaps and generate compliant physician queries when needed.
• Support audits and educational activities for CDI programs.

Connaissances

DRG validation

ICD-10-CM/PCS coding

POA/SOI/ROM/CMI understanding

AHIMA/ACDIS guidelines

Query generation

Formation

RHIA/RHIT certification

Bachelor's degree in health information management

Description du poste

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:Join a Team of Industry-Leading Experts and Help Shape the Future of Revenue IntegrityAre 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.**This is a remote position**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.What You'll DoThe 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) indicatorsSeverity of Illness (SOI)Risk of Mortality (ROM)Case Mix Index (CMI)Hierarchical Condition Category (HCC) captureOther coding and reimbursement factorsUtilize current coding references and clinical criteria including:ICD-10-CM/PCSCMS GuidelinesMCGInterQualNational Coverage Determinations (NCDs)Local Coverage Determinations (LCDs)Payer clinical policy guidelinesAdhere 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.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.