DRG Validation Auditor - Remote

Overview

This role involves working remotely as a DRG validation auditor, focusing on coding-related denials, reimbursement audits, and clinical documentation improvement. The auditor will collaborate with a diverse team to enhance data quality and medical coding practices using advanced machine learning software.

In Short

• Remote position requiring expertise in coding and auditing.
• Focus on inpatient MS-DRG/APR-DRG and outpatient CPT-4/HCPCS.
• Work with a team of clinicians, engineers, and product managers.
• Validate accuracy of various coding standards and claims.
• Identify and resolve coding discrepancies.
• Communicate findings to project leads and teams.
• Maintain confidentiality and integrity of health information.
• Requires extensive knowledge of healthcare coding practices.
• 5+ years of auditing experience required.
• Certification in relevant coding fields is needed.

Requirements

• Experience in coding, billing, auditing, and reimbursement.
• Extensive pediatric inpatient facility experience.
• Familiarity with clinical documentation improvement practices.
• Knowledge of Official Coding Guidelines.
• Proficiency in coding software and EHR systems.
• Detail-oriented with strong organizational skills.
• Ability to think critically and resolve challenges.
• Strong accountability and proactive work ethic.
• High level of anatomy and physiology knowledge.
• Must hold relevant certifications (RHIA, RHIT, CCS, etc.).

Benefits

• Opportunity to work with a high-performing team.
• Dynamic work environment.
• Contribute to the development of auditing software.
• Engagement in innovative healthcare solutions.
• Flexible working conditions.