DRG Auditor

This is a fully remote position, open to applicants in United States.

📋 Description

• Evaluate inpatient claims within the DRG database for accuracy in diagnosis, procedures, grouping logic, and reimbursement.

• Examine weekly hospital billing files to detect underpaid claims.

• Perform post-bill reviews of medical records to determine the accuracy and completeness of diagnosis and procedure coding.

• Navigate through medical records and assess specific sections such as discharge summaries and operative reports.

• Align clinical documentation with ICD-10 codes and confirm the accuracy of DRG classifications.

• Identify and rectify undercoded or misclassified diagnoses and procedures.

• Utilize the Health ROI system edits to uncover high-value reimbursement prospects.

• Develop reimbursement enhancement proposals for client evaluation and approval.

• Partner with leadership on prioritizing cases and managing workflows.

• Stay updated on coding revisions, payer regulations, and changes in DRG.

• Analyze client reports to discover new revenue opportunities related to inpatient DRG.

• Manage PHI and confidential proprietary data with utmost privacy and security.

⛳️ Requirements

• An associate's or bachelor's degree in health information management or a related discipline is required.

• Certification as a Certified Coding Specialist (CCS) is mandatory.

• 2 to 3 years of experience in DRG validation, inpatient medical coding, or a related coding review is necessary.

• A strong grasp of ICD-10-CM/PCS coding guidelines is essential.

• Familiarity with DRG reimbursement methods and hospital billing procedures is required.

• Capability to read and interpret clinical documentation across nursing, operative, radiology, and pharmacy departments is important.

• Experience in a post-bill coding setting is preferred.

• Knowledge of DRG grouping software and billing databases is beneficial.

• Proficiency in navigating digital platforms, EMRs, and data systems is necessary.

• Strong computer skills, including proficiency in MS Office applications such as Word, Excel, and Outlook, are essential.

• Ability to work autonomously in a detail-oriented, data-focused environment is required.

• Excellent communication and documentation abilities are needed.

• High integrity and professionalism in handling PHI and confidential information are vital.

• Capacity to analyze extensive medical and billing data is required.

• Strong attention to detail along with analytical, problem-solving, prioritization, and project management skills is necessary.

• Experience dealing with external clients, demonstrating customer service skills and business insight is important.

• Ability to meet deadlines and manage a high-volume, time-sensitive workload is crucial.

• Consistent and punctual attendance is expected.

🏝️ Benefits

• Full-time employment.

• Option for remote work.

• Opportunities for professional growth and development.

• Access to tools, resources, and support for career advancement.

• A flexible, family-oriented work environment.

• Support for work-life balance.