DRG Revenue Integrity Auditor - REMOTE

CorroHealth, Inc.; United States; À distance; USD 95 000 - 125 000; Plein temps

Résumé du poste

CorroHealth, Inc. seeks a DRG Revenue Integrity Auditor to validate DRGs and ensure accurate coding for inpatient records. You’ll work with physicians, coders, and clients to uphold high standards of clinical documentation and revenue integrity.

This is a remote position with opportunities for mentorship, training development, and participation in client-facing initiatives. Five+ years in acute care or vendor settings and a CCS certification are required.

Qualifications

• Five or more years in an acute care setting or a third‑party vendor as a DRG Auditor orCDS.
• CCS certification is required; CCDS or CDIP is a plus.

Responsabilités

• Perform comprehensive DRG validation and quality audits on inpatient medical records to ensure accurate representation of each patient's clinical story.
• Ensure ICD-10-CM/PCS codes accurately reflect the patient's condition and treatment.
• Validate proper sequencing and accuracy of diagnoses and procedures.
• Review Present on Admission indicators, Severity of Illness, Risk of Mortality, Case Mix Index, HCC capture, and other coding factors.
• Utilize ICD-10-CM/PCS, CMS Guidelines, MCG, InterQual, NCDs, LCDs, and payer guidelines.
• Adhere to AHIMA and ACDIS coding guidelines and CDI best practices.
• Identify documentation gaps and formulate compliant physician queries.
• Mentor and provide shadowing for new team members; support training content development.
• Participate in internal and external audits of CDI programs and client-facing initiatives.
• Protect PHI and comply with all regulatory requirements.

Connaissances

DRG auditing

Analytical skills

Team player

Communication

Work with multiple clients

Numerical proficiency

Formation

CCS certification

CDDS/CDIP qualification (plus)

Outils

MS Word

MS Excel

MS Outlook

Teams

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.

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 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. While partnering with exceptional clients and colleagues,
**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 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

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 Member is 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.