Remote DRG Validation Auditor Inpatient Audit Expert

International Association of Insurance Professionals (IAIP); Northern (KY); Hybrid; USD 70,000 - 110,000; Full time

Benefits offered by this job

Remote work options

Competitive compensation

Job summary

Penstock is seeking a DRG Validation Auditor to review inpatient claims and assure fair and accurate DRG payments based on chart documentation and ICD-10 conventions.

The role requires strong auditing skills, a solid coding background, and the ability to work independently in a remote, time-zone aware environment. Penstock emphasizes integrity and continuous improvement in payment integrity.

Qualifications

• Minimum of an associate degree.
• RHIT or RHIA credential.
• CCS or CIC credential.
• CDIP, CCDS, or CDEI credential.
• 3+ years of ICD-10 inpatient coding experience.
• 1+ years of clinical experience in a healthcare facility setting.
• 3+ years of auditing experience (or demonstrated equivalent).
• 1+ years of auditing experience in a payor setting.
• 1+ years of experience in Inpatient Rehabilitation coding/auditing.
• 1+ years of experience in Inpatient Psychiatric coding/auditing.
• Comprehensive understanding of ICD-10-CM Inpatient Coding Guidelines, AHA Coding Clinic, and DRG grouping mechanics.
• Strong current clinical knowledgebase.
• Familiarity with Clinical Documentation Integrity practices.
• HIPAA and PHI/PII safeguarding knowledge.
• Independent research capability.
• Microsoft Word, Excel, PowerPoint proficiency.

Responsibilities

• Review inpatient claims and medical records to verify DRG accuracy.
• Cite ICD-10-CM/ICD-10-PCS guidelines and AHIMA/AHA references in audit rationales.
• Maintain up-to-date knowledge of coding, regulatory, and industry changes.
• Identify and develop new audit concepts and opportunities.
• Communicate findings clearly to management and stakeholders.
• Serve as a Payment Integrity expert for the team and organization.
• Meet or exceed performance and quality standards.
• Support senior auditors as needed.

Skills

Critical thinking

Communication skills

Independent work

Education

Associate degree

RHIT/RHIA

CCS/CIC

CDIP/CCDS/CDEI

Tools

Microsoft Word

Microsoft Excel

Microsoft PowerPoint

Job description

Penstock is seeking a DRG Validation Auditor to review inpatient claims and assure fair and accurate DRG payments based on chart documentation and ICD-10 conventions.

The role requires strong auditing skills, a solid coding background, and the ability to work independently in a remote, time-zone aware environment. Penstock emphasizes integrity and continuous improvement in payment integrity.