DRG Validation Auditor

HCA Healthcare; Jacksonville (FL); Remote; USD 65,000 - 90,000; Full time

Benefits offered by this job

Comprehensive benefits

Wellbeing support

Paid time off

401(k) Plan with matching

Tuition assistance

Fertility & family-building benefits

Job summary

Parallon, a part of HCA Healthcare, is seeking a DRG Validation Auditor (work-from-home) to perform internal quality reviews of inpatient and outpatient coding for accuracy and compliance. You will ensure alignment with national guidelines, HSC and company policies while supporting proper reimbursement and data integrity.

You will lead audits, monitor productivity and accuracy, and coordinate with staff to maintain current coding knowledge and policies in a remote work setting.

Qualifications

• High school diploma and/or GED preferred
• Undergraduate degree in HIM/HIT preferred
• Minimum of 3 years acute care inpatient/outpatient coding experience preferred
• Minimum of 3 years coding auditing/monitoring experience strongly preferred
• RHIA, RHIT and/or CCS preferred

Responsibilities

• Leads, coordinates and performs all functions of quality reviews (routine, pre-bill, policy driven and incentive plan driven) for inpatient and/or outpatient coding across multiple HSCs
• Assists in ensuring HSC coding staff adherence with coding guidelines and policy
• Demonstrates and applies expert level knowledge of medical coding practices and concepts
• Participates on special reviews or projects
• Maintains or exceeds 95% productivity standards
• Maintains or exceeds 95% accuracy
• Meets all educational requirements as stated in current Company policy
• Reviews all official data quality standards, coding guidelines, Company policies and procedures, and clinical/medical resources to assure coding knowledge and skills remain current

Skills

Quality audits

Medical coding

DRG validation

HIM knowledge

Attention to detail

Education

High school diploma/GED preferred

Undergraduate degree in HIM/HIT preferred

RHIA/RHIT/CCS preferred

Job description

Last year our HCA Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a DRG Validation Auditor with Parallon you can be a part of an organization that is devoted to giving back!

Candidates must have a background in Facility Inpatient Coding and DRG Validation.

Job Summary and Qualifications

As a work from home Inpatient Coding Auditor, you will be responsible for performing internal quality assessment reviews on Health Information Management Service Center (HSC) coders to ensure compliance with national coding guidelines, the HSC coding policies and the Company coding policies for complete, accurate and consistent coding which result in appropriate reimbursement and data integrity. You will review outcomes are communicated to the HSC team to improve the accuracy, integrity and quality of patient data, to ensure minimal variation in coding practices and to improve the quality of physician documentation within the body of the medical record to support code assignments.

What you will do in this role:

• Leads, coordinates and performs all functions of quality reviews (routine, pre-bill, policy driven and incentive plan driven) for inpatient and/or outpatient coding across multiple HSCs

• Assists in ensuring HSC coding staff adherence with coding guidelines and policy

• Demonstrates and applies expert level knowledge of medical coding practices and concepts

• Participates on special reviews or projects

• Maintains or exceeds 95% productivity standards

• Maintains or exceeds 95% accuracy

• Meets all educational requirements as stated in current Company policy

• Reviews all official data quality standards, coding guidelines, Company policies and procedures, and clinical/medical resources to assure coding knowledge and skills remain current

What qualifications you will need:

• High school diploma and/or GED preferred

• Undergraduate degree in HIM/HIT preferred

• Minimum of 3 years acute care inpatient/outpatient coding experience preferred

• Minimum of 3 years coding auditing/monitoring experience strongly preferred

• RHIA, RHIT and/or CCS preferred

Benefits

Parallon, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services

• Wellbeing support, including free counseling and referral services

• Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence

• Savings and retirement resources , including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling

• Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing

• Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts

Note: Eligibility for benefits may vary by location.

Parallon provides full-service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing. We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000 colleagues, and serves close to 1,000 hospitals and 3,000 physician practices, all making an impact on patients, providers and their communities.

HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

"There is so much good to do in the world and so many different ways to do it."- Dr. Thomas Frist, Sr.

HCA Healthcare Co-Founder

Be a part of an organization that invests in you! We are reviewing applications for our Coding Quality Audit Reviewer opening. Qualified candidates will be contacted for interviews.

We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.