DRG Coding Auditor – MS-DRG, APR-DRG

This is a fully remote position, open to applicants in California, +4 more states.

📋 Description

• Conduct audits on inpatient medical records to produce high-quality recoverable claims for both the company and its clients.

• Execute clinical reviews of medical documentation to assess the precision of coding and DRG assignments.

• Examine DRG coding through medical records and statements from attending physicians in acute care hospitals.

• Analyze and audit claims utilizing medical chart coding principles, clinical guidelines, and objective auditing practices.

• Leverage advanced ICD-10 coding knowledge, clinical guidelines, and industry insight to support conclusions.

• Employ auditing tools, workflow systems, and reference materials to make audit decisions and create audit findings letters.

• Ensure adherence to accuracy and quality standards in auditing concepts, valid claim identification, and documentation.

• Discover new claim types and potential recoveries, such as re-admissions, transitions from inpatient to outpatient, and HACs.

• Propose and formulate recommendations for concepts, process improvements, and efficiency enhancements.

⛳️ Requirements

• AA/AS degree or a minimum of 5 years of experience in claims auditing, quality assurance, or recovery auditing.

• Must possess at least one certification: RHIA, RHIT, CCS, CIC, or Certified Clinical Documentation Specialist (CCDS).

• Five years of experience working with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG.

• Preferred experience in a vendor-based DRG Coding/Clinical Validation Audit setting or a hospital coding or quality assurance environment.

• Comprehensive knowledge of medical claims billing/payment systems, provider billing guidelines, payer reimbursement policies, billing validation criteria, and coding terminology preferred.

• BA/BS degree is preferred.

• Applicants must live within a reasonable commuting distance of the job location unless an accommodation is provided.

🏝️ Benefits

• $1,500 sign-on bonus.

• Comprehensive benefits package.

• Incentive and recognition programs.

• Equity stock purchase opportunities.

• 401(k) contributions and matching.

• Merit increases.

• Paid holidays.

• Paid Time Off.

• Incentive bonus programs.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• Short-term disability benefits.

• Long-term disability benefits.

• Stock purchase plan.

• Life insurance.

• Wellness programs.

• Financial education resources.

• Virtual full-time work arrangement.

• Required in-person training sessions.

• Flexible work-life integration.