DRG Validation Auditor | Inpatient Coding & Reimbursement

Insight Global; United States; On-site; USD 86,000 - 105,000; Full time

Job summary

Insight Global is seeking experienced DRG Validation Auditors to support a leading healthcare analytics organization. This role is ideal for professionals with a strong background in inpatient coding, clinical documentation improvement, DRG validation, and healthcare auditing who thrive in a production-driven environment.

This position is responsible for auditing inpatient medical records, validating DRG assignments, identifying coding inaccuracies, and generating recoverable claims.

Qualifications

• Current experience performing DRG validation audits or DRG auditing.
• Strong inpatient healthcare experience.
• Experience reviewing medical records and clinical documentation.
• Knowledge of ICD-9, ICD-10, and DRG methodologies.
• Experience working in a metrics-driven environment.

Responsibilities

• Review inpatient medical records to validate coding accuracy and DRG assignment.
• Apply advanced ICD-10 coding knowledge and clinical guidelines during audit review.
• Audit claims related to MS-DRG, AP-DRG, and APR-DRG payment methodologies.
• Identify coding discrepancies and reimbursement opportunities.
• Generate detailed audit findings and supporting documentation.
• Utilize proprietary audit systems to document determinations and prepare audit letters.
• Meet established productivity, accuracy, and quality metrics.
• Recommend process improvements and identify additional recovery opportunities.

Skills

DRG validation audits

Inpatient coding

Clinical documentation

DRG methodologies

Healthcare auditing

Education

BSN, RN, or LPN

CCS

CCDS

CDIP

CPC

RHIA

RHIT

Job description

Insight Global is seeking experienced DRG Validation Auditors to support a leading healthcare analytics organization. This role is ideal for professionals with a strong background in inpatient coding, clinical documentation improvement, DRG validation, and healthcare auditing who thrive in a production-driven environment.

This position is responsible for auditing inpatient medical records, validating DRG assignments, identifying coding inaccuracies, and generating recoverable claims.