Remote DRG Validation Auditor (ICD-10 Expert)

Insight Global; United States; On-site; USD 81,000 - 109,000; Full time

Job summary

Insight Global is seeking a DRG Validation Auditor to work 100% remotely. This role requires extensive ICD-9/10CM, DRG knowledge, and inpatient nursing or equivalent clinical coding credentials.

The auditor will review medical records, substantiate DRG assignments, and generate high-quality recoverable claims for clients. Candidates should have 5–7+ years in coding/payor guidelines and be proficient with MS-DRG, AP-DRG, APR-DRG systems.

Qualifications

• 5–7+ years with ICD-9/10CM, MS-DRG, AP-DRG, APR-DRG and related reimbursement policies.
• Expert DRG and ICD-10 coding knowledge.
• RN inpatient with coding/clinical documentation certification (2 years).
• Alternatively, RHIA/RHIT with medical coding degree or CCS with strong clinical knowledge.

Responsibilities

• Audit inpatient medical records and generate high-quality recoverable claims.
• Perform clinical reviews to evaluate coding and DRG assignment accuracy.
• Integrate medical coding principles with clinical guidelines for audits.
• Utilize auditing systems to determine audit outcomes and generate letters.

Skills

ICD-10 coding

DRG & ICD-10 expertise

Clinical documentation

Nursing background (RN inpatient)

Audit/claims review

Education

RN inpatient with coding certification

RHIA/RHIT or CCS with coding background

Tools

Proprietary auditing systems

Job description

Insight Global is seeking a DRG Validation Auditor to work 100% remotely. This role requires extensive ICD-9/10CM, DRG knowledge, and inpatient nursing or equivalent clinical coding credentials.

The auditor will review medical records, substantiate DRG assignments, and generate high-quality recoverable claims for clients. Candidates should have 5–7+ years in coding/payor guidelines and be proficient with MS-DRG, AP-DRG, APR-DRG systems.