Inpatient DRG Auditor

Job Summary

Focused on auditing inpatient DRG claims, the full-time Inpatient DRG Auditor will perform coding and clinical chart validation, utilizing advanced clinical expertise and proprietary audit tools to ensure coding accuracy and compliance with treatment standards.

Key responsibilities

• Conduct audits of inpatient DRG claims using medical chart coding principles and client-specific guidelines
• Utilize proprietary auditing systems to generate audit determinations and maintain production and accuracy standards
• Identify potential claims for additional recoveries and suggest process improvements for auditing activities

Required qualifications

• Associate or bachelor's degree in Health Information Management (RHIA or RHIT) or equivalent experience (5+ years) in claims auditing
• Certification in coding/CDI (RHIA, RHIT, CPC, CCS, CIC, CDIP, or CCDS) required
• 5 to 7+ years of experience with ICD-9/10CM, MS-DRG, and medical claims billing/payment systems
• Expert knowledge of coding guidelines, regulatory compliance, and medical necessity criteria
• Proficiency in Microsoft Office applications and excellent communication skills