CCS Certified DRG Auditor

Job Summary

To support a growing Payment Integrity team, the remote CCS Certified DRG Auditor will ensure accurate claims processing by reviewing claims for DRG-related issues, identifying overpayments, and collaborating with clinical and claims teams to maintain compliance and efficiency.

Key responsibilities

• Review claims for DRG-related issues and drive accurate payments on inpatient services
• Identify and recover overpayments to ensure compliance with quality assurance standards
• Engage in discussions with medical professionals to verify clinical rationale behind billed procedures

Required qualifications

• CCS or CIC certification is required
• Knowledge of DRG pricing methodology is required
• At least 1 year of direct inpatient clinical coding experience
• Experience in Medicare or Medicare Advantage payment integrity or claims operations is preferred
• Strong computer skills in Excel and PowerPoint