Remote DRG Auditor & ICD-10 Coding Expert

EnableComp; Franklin (TN); Hybrid; USD 65,000 - 95,000; Full time

Job summary

EnableComp seeks a DRG Auditor to review post-billed inpatient claims, validate missed reimbursement opportunities, and optimize hospital revenue using ICD-10 coding. Working within a DRG database, you will assess coding accuracy and DRG grouping to recommend improvements for clients nationwide.

The role requires CCS certification and a strong grasp of medical record documentation, DRG reimbursement methodology, and privacy compliance when handling PHI.

Qualifications

• Associate's or bachelor's degree in health information management or related field.
• RHIT or RHIA credentialed individuals encouraged.
• Certified Coding Specialist (CCS) certification required.
• 2-3 years’ experience in DRG validation, inpatient medical coding, or related coding review.
• Strong understanding of ICD-10-CM/PCS coding guidelines and DRG reimbursement methodology.

Responsibilities

• Review inpatient claims in the DRG database for diagnosis, procedures, grouping logic, and reimbursement accuracy.
• Analyze weekly hospital billing files, identifying underpaid claims based on ICD-10 diagnosis and procedure codes.
• Conduct post-bill medical record reviews to determine if submitted codes are accurate and complete.
• Navigate medical records to extract relevant sections for coding reviews.
• Match documentation to ICD-10 codes to ensure DRG accuracy.
• Identify and correct under-coded or misclassified diagnoses and procedures.
• Utilize Health ROI edits to detect high-value DRG opportunities.
• Make reimbursement improvement recommendations for client review and approval.
• Collaborate with leadership on case prioritization and workflow management.
• Stay informed on coding updates, payer guidelines, and DRG changes.
• Analyze client reporting and identify new inpatient DRG revenue opportunities.
• Other duties as required.

Job description

EnableComp seeks a DRG Auditor to review post-billed inpatient claims, validate missed reimbursement opportunities, and optimize hospital revenue using ICD-10 coding. Working within a DRG database, you will assess coding accuracy and DRG grouping to recommend improvements for clients nationwide.

The role requires CCS certification and a strong grasp of medical record documentation, DRG reimbursement methodology, and privacy compliance when handling PHI.