DRG Validation Coding Auditor
Core
Performs documentation and coding audits for acute inpatient services to identify errors, ensure compliance, and optimize reimbursement by verifying diagnosis/procedure codes against medical records.
Role type
Senior IC DRG Validation Coding Auditor
Builds
Accurate billing submissions and compliant revenue cycle processes for hospital clients
Domain
Healthcare Revenue Cycle Management / Medical Coding
Required skills
DRG coding expertise (MS, APR, Tricare), ICD-10-CM/PCS proficiency, clinical documentation review, HIPAA compliance, medical terminology, claims analysis, audit quality management
Preferred skills
CCS, CPC, RHIA, RHIT certifications, EMR/encoder proficiency, process improvement, AI tool exploration
Technologies
Proprietary encoder tools, EMR systems, Microsoft Office suite
Responsibilities
Conduct independent DRG coding and clinical reviews to verify accuracy and severity of patient conditions; Assess clinical documentation support for coded diagnoses and procedures; Identify potential overpayments or underpayments via claims analysis; Write clear recommendations and provide feedback/education to coders; Maintain productivity and quality goals; Stay current on coding guidelines and regulations
Seniority
Mid-Senior level, hands-on IC