Remote RN DRG Auditor — Clinical Coding Expert

University of Minnesota School of Nursing; Plymouth (MN); Remote; USD 48,000 - 87,000; Full time

Benefits offered by this job

Paid time off

Health plan options

Remote work

Job summary

Optum is seeking a Clinical DRG RN auditor who will validate ICD-10-CM/PCS codes and DRG assignments for inpatient claims. You will write clear rationales and use proprietary tools to move claims through workflow, contributing to accurate reimbursements.

The role supports remote work from anywhere in the U.S. and requires strong coding knowledge, including MS-DRG/APR-DRG, ICD-10 guidelines, and CMS rules.

Qualifications

• Associate's degree required.
• Unrestricted RN license required.
• CCS/CIC or willing to obtain certification within 6 months of hire.
• 2+ years MS DRG/APR DRG coding experience in hospital setting.

Responsibilities

• Conduct MS-DRG and APR-DRG coding reviews to verify DRG assignment and reimbursement.
• Identify ICD-10-CM/PCS code assignment, sequencing, POA, and discharge disposition per CMS guidelines.
• Apply ICD-10 Official Guidelines and AHA Coding Clinic citations to substantiate code assignments.
• Perform clinical coding review to ensure accuracy of medical coding and billing.

Skills

Independent work

Communication skills

Time management

Analytical thinking

Education

Associate's degree

Tools

DRG encoder tools (3M)

Microsoft Excel

Job description

Optum is seeking a Clinical DRG RN auditor who will validate ICD-10-CM/PCS codes and DRG assignments for inpatient claims. You will write clear rationales and use proprietary tools to move claims through workflow, contributing to accurate reimbursements.

The role supports remote work from anywhere in the U.S. and requires strong coding knowledge, including MS-DRG/APR-DRG, ICD-10 guidelines, and CMS rules.