Inpatient DRG Coding Auditor

This is a fully remote position, open to applicants in Alabama, +13 more states.

📋 Description

• Conduct post-discharge and pre-bill reviews of inpatient medical records for designated payer populations.

• Assess the accuracy and thoroughness of diagnosis and procedure coding, DRG assignment, and abstracted data, including POA and Discharge Disposition.

• Analyze inconsistencies between Clinical Documentation Specialist (CDS) DRG and Coder DRG.

• Evaluate non-CC/MCC records to ascertain if they were incorrectly coded or if additional documentation is needed.

• Collaborate with Coders and CDSs to formulate and initiate physician queries.

• Carry out reviews promptly to uphold the DNFB target of 4 days.

• Organize educational and training sessions on technical coding and clinical subjects for coding personnel.

• Facilitate remediation actions as necessary.

• Provide education to physicians, nursing, and other clinical staff in partnership with Coding leadership, Quality nurses, and the CDS team to enhance documentation quality.

• Examine DRG Reassignment letters and aid in drafting Appeal letters.

⛳️ Requirements

• A high school diploma is required.

• At least five (5) years of experience in coding ICD-10 within an acute care environment.

• Prior experience conducting DRG coding audits is necessary.

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

• Familiarity with DRG and grouping methodologies (MS DRG's and AP DRG's), particularly regarding diagnoses/procedures that influence DRG assignment.

• Basic computer proficiency in word processing and spreadsheet applications.

• Strong interpersonal skills are essential.

• Exceptional prioritization and organizational abilities are required.

• Must reside in and be authorized to work in Alabama, Arkansas, Florida, Georgia, Illinois, Louisiana, Michigan, New Hampshire, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, or Wisconsin.

• Capacity to meet physical demands, including lifting up to 50 lbs and carrying objects weighing up to 25 lbs.

• Ability to work in environments with listed hazards and utilize personal protective equipment, including respirators, when necessary.

• Shift work and travel may be part of the role.

🏝️ Benefits

• Comprehensive health benefits that commence on the first day of employment.

• Assistance and reimbursement programs for student loan repayment.

• Family-oriented benefits available.

• Wellness incentives to promote health and wellbeing.

• Ongoing mentorship, development, and leadership programs provided.