Clinical DRG Auditor

Job Summary

A company is looking for a DRG Validation Auditor (Clinical & Coding).

Key Responsibilities

• Analyze and audit inpatient claims, integrating coding principles and clinical guidelines
• Utilize proprietary auditing systems to make determinations and generate audit letters
• Maintain production goals and achieve accuracy and quality standards set by management

Required Qualifications

• Associate or bachelor's degree in nursing or Health Information Management (RHIA or RHIT)
• High school diploma or GED with 5+ years of experience in claims auditing or recovery auditing
• Coding/CDI certification (RHIA, RHIT, CPC, CCS, CIC, CDIP, or CCDS)
• 5 to 7+ years of experience with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG
• Proficiency in Word, Access, Excel, TEAMS, and other applications