Remote DRG Audit RN: Clinical Validation & Coding

Sacbar; Plymouth (MN); Hybrid; USD 48,216,000 - 86,100,000; Full time

Benefits offered by this job

Sign-on bonus

Remote work option

Job summary

Optum, a part of UnitedHealth Group, seeks a Clinical DRG RN auditor to review MS-DRG and APR-DRG coding for inpatient claims and identify overpayments. The role emphasizes ICD-10-CM/PCS accuracy, documenting rationales, and maintaining high-quality audit outputs.

You will work remotely from anywhere in the U.S. and use proprietary tools to support audits, with sign-on bonus available for external applicants. Join a team focused on improving health outcomes and reimbursement integrity.

Qualifications

• Associate's degree required.
• RN license and CCS/CIC certification within 6 months of hire.
• 2+ years MS-DRG/APR DRG coding experience in hospital environment.
• 2+ years ICD-10-CM coding experience including SOI/MCCs.
• 2+ years ICD-10-PCS coding experience including PCS components.

Responsibilities

• Conduct MS-DRG and APR-DRG coding reviews to verify DRG assignment and reimbursement.
• Identify ICD-10-CM/PCS code assignments, sequencing, POA, and discharge disposition per CMS guidelines.
• Apply ICD-10 Official Guidelines and AHA Coding Clinic citations in coding decisions.
• Perform clinical coding reviews to ensure accuracy of medical coding.
• Demonstrate anatomy and physiology knowledge for ICD-10-PCS code assignment.
• Write clear rationales supporting findings per coding guidelines.
• Use encoder tools to move claims through workflow correctly.
• Stay current with coding guideline updates and client requirements.
• Manage daily case reviews with high quality.
• Provide clinical support to other teams.
• Work in a high-volume matrix-driven environment.

Skills

RN licensure

CCS/CIC

MS-DRG/APR DRG coding

ICD-10-CM coding

ICD-10-PCS coding

Audit rationale writing

Excel

Remote work

Education

Associate's degree

Tools

3M DRG Encoder

Proprietary workflow systems

Job description

Optum, a part of UnitedHealth Group, seeks a Clinical DRG RN auditor to review MS-DRG and APR-DRG coding for inpatient claims and identify overpayments. The role emphasizes ICD-10-CM/PCS accuracy, documenting rationales, and maintaining high-quality audit outputs.

You will work remotely from anywhere in the U.S. and use proprietary tools to support audits, with sign-on bonus available for external applicants. Join a team focused on improving health outcomes and reimbursement integrity.