Remote DRG Coding RN Auditor — Clinical Expert

Internationalinsuranceprofessionals; Plymouth (MN); Remote; USD 48,000 - 87,000; Full time

Benefits offered by this job

Paid time off

Medical plan options

Dental, Vision, Life & AD&D

401(k)

Education reimbursement

Employee discounts

Employee assistance program

Referral bonus program

Voluntary benefits

Job summary

Optum in the United States is seeking a Clinical DRG RN auditor to apply MS-DRG/APR-DRG coding expertise to inpatient claims. You will validate ICD-10 coding, DRG assignments, and discharge statuses, producing clear rationales and supporting audit findings.

You can telecommute from anywhere within the U.S. The role demands RN licensure, CCS/CIC or willingness to obtain certification, and multiple years of MS DRG/APR DRG coding experience in hospital settings.

Qualifications

• Associate's degree required; RN licensure required.
• 2+ years MS DRG/APR DRG coding in hospital setting.
• 2+ years ICD-10-CM coding experience; knowledge of SOI/ROM.

Responsibilities

• Conduct MS-DRG and APR-DRG coding reviews to verify DRG assignments and reimbursements.
• Apply ICD-10-CM/PCS guidelines and coding criteria to substantiate codes.
• Write clear rationales supporting audit findings and utilize encoder tools efficiently.
• Maintain high-quality daily case review and support other investigative areas.
• Work in a high-volume production environment with matrix-driven processes.

Skills

MS DRG coding

APR DRG coding

ICD-10-CM coding

ICD-10-PCS coding

RN license

CCS/CIC certification

Education

Associate's degree

Tools

DRG encoder tools (e.g. 3M)

Job description

Optum in the United States is seeking a Clinical DRG RN auditor to apply MS-DRG/APR-DRG coding expertise to inpatient claims. You will validate ICD-10 coding, DRG assignments, and discharge statuses, producing clear rationales and supporting audit findings.

You can telecommute from anywhere within the U.S. The role demands RN licensure, CCS/CIC or willingness to obtain certification, and multiple years of MS DRG/APR DRG coding experience in hospital settings.