Senior DRG Clinical Auditor

Job Summary

A company is looking for a Senior DRG Clinical Auditor to analyze complex healthcare claims for accurate billing and compliance.

Key Responsibilities

• Review and analyze complex inpatient and outpatient charges across various revenue centers
• Perform detailed itemized bill reviews to identify billing irregularities and apply national coding standards
• Document audit results and ensure compliance with HIPAA regulations and reimbursement policies

Required Qualifications

• High school diploma and 5+ years of DRG bill review experience, or completion of a medical license or coding certification
• Extensive knowledge of inpatient and outpatient hospital billing, including UB-04 forms and coding systems
• Strong working knowledge of DRG reimbursement methodology
• Familiarity with payer reimbursement policies and regulatory standards
• Experience reviewing medical records and claim documentation