DRG Validation Auditor

Insight Global; United States; Remote; USD 60,000 - 100,000; Full time

Job summary

An established industry player is looking for a DRG Validation Auditor for a remote position. This role requires a candidate with extensive experience in facility-based nursing and a strong understanding of reimbursement guidelines. As a key player, you will audit inpatient medical records, ensuring accuracy in coding and DRG assignment, while generating high-quality recoverable claims. Your expertise in coding principles and clinical guidelines will be vital in maintaining production goals and achieving quality standards. If you are passionate about improving healthcare processes and have the required qualifications, this opportunity is perfect for you.

Qualifications

• 5-7+ Jahre Erfahrung mit ICD-9/10CM und DRG-Systemen.
• Registered Nurse (RN) mit Erfahrung in der klinischen Dokumentation.

Responsibilities

• Auditing von medizinischen Unterlagen zur Sicherstellung der Kodierungsgenauigkeit.
• Identifizieren von Ansprüchen mit zusätzlichen Rückforderungen und Verbesserungsvorschlägen.

Skills

ICD-9/10CM

MS-DRG

AP-DRG

APR-DRG

Clinical Documentation

Inpatient Coding

Education

Registered Nurse (RN)

Degree in RHIM

Degree in RHIA

Degree in RHIT

Certification in CCS

Tools

Proprietary Auditing Systems

Job description

Insight Global is seeking a DRG Validation Auditor for a remote position. The ideal candidate has extensive experience in facility-based nursing, clinical documentation, or inpatient coding, with a strong understanding of reimbursement guidelines, specifically MS-DRG, AP-DRG, and APR-DRG payment systems. The role involves auditing inpatient medical records and generating high-quality recoverable claims, performing clinical reviews to ensure coding and DRG assignment accuracy. Key responsibilities include:

1. Integrating medical chart coding principles, clinical guidelines, and objectivity in audits.
2. Utilizing proprietary auditing systems proficiently to make determinations and generate audit letters.
3. Maintaining production goals and achieving accuracy and quality standards.
4. Identifying claims with additional recoveries and suggesting process improvements.

Required skills and experience:

• 5-7+ years working with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG systems.
• Registered Nurse (RN) with inpatient experience and coding/clinical documentation certification, or a degree in RHIM, RHIA, RHIT, or CCS with strong clinical knowledge.