State Licensed DRG Auditor
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Job Summary
Working full-time during off-hour shifts, the State Licensed DRG Auditor will conduct DRG validation for prepay and retrospective audits, focusing on auditing inpatient claims and ensuring coding accuracy without access to medical records.
Key responsibilities
- Analyzes and audits claims by applying advanced ICD-10 coding expertise and clinical guidelines
- Effectively utilizes proprietary auditing systems to make determinations and generate audit letters
- Maintains production and accuracy standards set by the audit operations management team
Required qualifications
- Associate or bachelor's degree in nursing or Health Information Management (RHIA or RHIT)
- Coding/CDI certification such as RHIA, RHIT, CPC, CCS, CIC, CDIP, or CCDS
- 5 to 7+ years of experience with ICD-9/10CM, MS-DRG, and medical claims billing/payment systems
- Expert knowledge of coding guidelines and compliance regulations
- Proficiency in Microsoft Office applications including Word, Access, and Excel
Complete Job Description
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