DRG / Inpatient Auditor III
New
J
JobgetherHealthcare auditing
100% remote within the United StatesFull-TimeMiddle
Salary73,000 - 98,700 USD per year
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Job Details
- Experience
- At least 4 years of experience in MS-DRG and/or APR-DRG inpatient coding
- Required Skills
- Microsoft Excel
Requirements
- Have at least 4 years of experience in MS-DRG and/or APR-DRG inpatient coding.
- Have strong knowledge of AHA Coding Clinic guidelines, ICD-10-CM/PCS regulations, and DRG reimbursement methodologies.
- Hold a professional coding or health information management certification, such as CCS, CIC, CPC, RHIA, or RHIT.
- Have a high school diploma or equivalent; additional education in healthcare, health information management, medical coding, or a related field is preferred.
- Bring experience conducting retrospective DRG audits and identifying potential reimbursement overpayments; this experience is highly desirable.
- Demonstrate advanced understanding of inpatient coding, medical record documentation, DRG assignment, and healthcare reimbursement processes.
- Be proficient with DRG encoder and auditing platforms, particularly 3M and Webstrat.
- Be proficient in Microsoft Office applications, particularly Excel, Word, and OneNote.
- Be able to review complex medical records with analytical and critical-thinking skills and attention to detail.
- Be able to produce clear, accurate, well-supported audit documentation.
- Work independently and manage deadlines and competing priorities in a fully remote environment.
- Travel up to 10% annually.
Responsibilities
- Conduct MS-DRG and APR-DRG coding audits to assess inpatient coding accuracy, validate DRG assignments, and identify potential reimbursement overpayments.
- Apply ICD-10-CM/PCS coding guidelines, AHA Coding Clinic guidance, and DRG reimbursement methodologies to perform reviews.
- Analyze and document overpayments through retrospective DRG audits, supporting findings with coding regulations and clinical documentation.
- Prepare clear audit reports with evidence-based findings and appropriate coding references.
- Use DRG encoder and auditing tools, including 3M and Webstrat.
- Meet established productivity and quality standards, including appeal uphold rates.
- Stay current with coding updates, reimbursement policies, and healthcare compliance requirements.
- Follow HIPAA requirements, data security standards, and internal policies when handling confidential healthcare information.
- Collaborate with colleagues and stakeholders to support knowledge sharing and consistent auditing practices.
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