RN DRG Auditor — Inpatient Payment Integrity

Alaffia Health; United States; À distance; USD 90 000 - 120 000; Plein temps

Avantages offerts par ce poste

401(k)

Medical, Dental, Vision benefits

Flexible paid vacation

Direct access to Leadership

Résumé du poste

Alaffia Health is seeking an experienced Clinical DRG Auditor to join our Payment Integrity team. In this role, you will perform inpatient DRG validation audits and clinical reviews of medical records and claims, leveraging your clinical expertise to identify unsupported DRGs and improve payment accuracy.

This position is ideal for an RN or LPN with hands-on experience in DRG validation, inpatient auditing, or CDI-adjacent review work.

Qualifications

• Active RN license required.
• 3+ years of experience in clinical DRG validation, inpatient clinical review, DRG auditing, CDI review, or similar payment integrity work.
• Strong ability to interpret inpatient medical records and assess clinical validity of diagnoses/procedures.
• Experience applying clinical judgment in reimbursement or audit context.

Responsabilités

• Perform clinical DRG audits on inpatient claims, validating diagnoses, CCs/MCCs, procedures, and discharge status.
• Evaluate whether documentation supports the billed DRG per CMS guidelines and payer policies.
• Apply clinical judgment to interpret complex inpatient records including physician notes, labs, imaging, and treatments.
• Identify documentation gaps and potential DRG upcoding or misclassification.

Connaissances

RN license

3+ years experience

Inpatient DRG validation

Clinical documentation interpretation

Outils

Audit platforms

EHR systems

Claims data systems

Description du poste

Alaffia Health is seeking an experienced Clinical DRG Auditor to join our Payment Integrity team. In this role, you will perform inpatient DRG validation audits and clinical reviews of medical records and claims, leveraging your clinical expertise to identify unsupported DRGs and improve payment accuracy.

This position is ideal for an RN or LPN with hands-on experience in DRG validation, inpatient auditing, or CDI-adjacent review work.