Certified DRG Claims Auditor

Job Summary

A company is looking for a DRG Claims Auditor, Recoveries.

Key Responsibilities

• Perform DRG validation and quality audits on claims, focusing on overpayment identification
• Utilize clinical knowledge to ensure accurate ICD-10-CM/PCS code assignments and compliance with guidelines
• Review and analyze claims to support medical policies and identify billing trends for potential recoveries

Required Qualifications

• Associate's degree required; Bachelor's degree preferred
• Certification as a Certified Inpatient Coder (CIC), Certified Professional Coder (CPC), or similar
• 5+ years of experience in DRG validation or claims auditing
• Thorough knowledge of ICD-10, CPT, HCPCS, and Revenue Billing Codes
• Nursing license preferred