DRG Validation Coding Auditor
New
E
EnsembleRevenue Cycle Management
Australia, Canada, India, United Kingdom, United StatesFull-TimeMiddle
Salary$69,400 to $104,100 annually
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Job Details
- Languages
- English
- Experience
- 5+ years of coding experience; 3+ years of facility coding audit experience
- Required Skills
- Microsoft OfficeHIPAA
Requirements
- 5+ years of coding experience.
- 3+ years of facility coding audit experience (e.g., DRG and APC Validation).
- Must hold at least one current professional certification: CCS (preferred), CPC, RHIA, or RHIT.
- Proficiency in multiple EMR systems, encoders, and Microsoft Office suite.
- Educated in and compliant with HIPAA regulations.
- Maintain strict confidentiality of patient and client information.
- Ability to read, write, and effectively communicate in English.
- Strong understanding of medical/surgical terminology.
- Bachelor's degree or equivalent experience.
- Must be inquisitive and open to innovation, including AI, to improve processes.
Responsibilities
- Perform documentation and coding audits for all acute inpatient services.
- Conduct DRG and clinical reviews to verify coding accuracy, DRG assignment, and clinical indicators.
- Assess whether clinical documentation supports coded diagnoses and procedures.
- Collaborate with CDI specialists to identify documentation and query opportunities.
- Provide feedback and education to acute inpatient coders referencing ICD-10-CM/PCS guidelines and AHA Coding Clinics.
- Analyze claims to identify potential overpayments or underpayments within a 30-day lookback period.
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