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 the company, its various business lines, and clients.

• Execute clinical evaluations of medical records and documentation to assess the accuracy of coding and DRG assignments.

• Review DRG coding in relation to medical records and statements from attending physicians at acute care hospitals.

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

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

• Employ audit tools, workflow systems, and reference materials to make audit determinations and generate findings letters.

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

• Recognize new claim types and potential recovery opportunities, such as readmissions, inpatient-to-outpatient cases, and HACs.

• Propose and develop recommendations for high-quality, high-value 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.

• Certification such as RHIA, RHIT, CCS, CIC, or Certified Clinical Documentation Specialist (CCDS) is required.

• At least 5 years of experience with ICD-9/10-CM, MS-DRG, AP-DRG, and APR-DRG.

• A BA/BS degree is preferred.

• Preferred experience includes working in vendor-based DRG coding or clinical validation audit settings, hospital coding, or quality assurance environments.

• A broad understanding of medical claims billing/payment systems, provider billing guidelines, payer reimbursement policies, billing validation criteria, and coding terminology is preferred.

• Candidates must live within a reasonable commuting distance of the job location unless an accommodation is legally required.

• New hires in certain patient/member-facing roles must be vaccinated against COVID-19 and influenza unless a valid exemption is provided.

🏝️ Benefits

• Comprehensive benefits package.

• Incentive and recognition programs.

• Equity stock purchase opportunities.

• 401k contribution.

• Merit-based increases.

• Paid holidays.

• Paid Time Off.

• Incentive bonus programs.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• Short-term disability benefits.

• Long-term disability benefits.

• 401(k) with matching contributions.

• Stock purchase plan.

• Life insurance coverage.

• Wellness programs.

• Financial education resources.

• Required in-person training sessions.

• Maximum flexibility and autonomy.

• Work-life integration.