DRG / Inpatient Auditor in United States at Jobgether

Conduct comprehensive MS-DRG and APR-DRG coding audits to assess inpatient coding accuracy, validate DRG assignments, and identify potential reimbursement overpayments.

Apply advanced knowledge of ICD-10-CM/PCS coding guidelines, AHA Coding Clinic guidance, and DRG reimbursement methodologies to perform accurate and defensible reviews.

Identify, analyze, and document overpayments through retrospective DRG audits, ensuring that findings are supported by relevant coding regulations and clinical documentation.

Prepare clear, concise, and comprehensive audit reports, providing evidence-based findings and appropriate coding references.

Utilize advanced DRG encoder and auditing tools, including 3M and Webstrat, to improve audit accuracy, efficiency, and consistency.

Maintain high-quality audit outcomes by meeting established productivity and quality standards, including strong appeal uphold rates.

Stay current with industry developments, coding updates, reimbursement policies, and healthcare compliance requirements to maintain expert-level knowledge.

Ensure strict adherence to HIPAA requirements, data security standards, and internal policies and procedures when handling confidential healthcare information.

Collaborate with colleagues and other stakeholders, contributing to knowledge sharing, continuous improvement, and consistent auditing practices.

Minimum of a high school diploma or equivalent; additional education in healthcare, health information management, medical coding, or a related field is preferred.

At least 4 years of experience in MS-DRG and/or APR-DRG inpatient coding, with strong knowledge of AHA Coding Clinic guidelines, ICD-10-CM/PCS regulations, and DRG reimbursement methodologies.

Previous experience conducting retrospective DRG audits and identifying potential reimbursement overpayments is highly desirable.

Professional coding or health information management certification, such as CCS, CIC, CPC, RHIA, or RHIT. Multiple relevant certifications are considered an advantage.

Advanced understanding of inpatient coding principles, medical record documentation, DRG assignment, and healthcare reimbursement processes.

Strong proficiency with DRG encoder and auditing platforms, particularly 3M and Webstrat.

Excellent analytical, critical-thinking, and problem-solving abilities, with exceptional attention to detail and consistency when reviewing complex medical records.

Strong written and verbal communication skills, including the ability to produce clear, accurate, and well-supported audit documentation.

Proficiency in Microsoft Office applications, particularly Excel, Word, and OneNote, alongside strong overall computer literacy.

Ability to work independently and remain productive in a fully remote environment while managing deadlines and competing priorities.

Strong time management, organizational, and interpersonal skills, with the ability to work effectively under pressure.

A collaborative mindset, commitment to continuous learning, and genuine interest in maintaining high standards in healthcare auditing.

Competitive annual base salary ranging from $73,000 to $98,700, depending on experience, qualifications, skills, and other relevant compensation factors.

Fully remote working arrangement within the United States.

Limited annual travel of up to 10% for team meetings and occasional client-site engagements.

Comprehensive healthcare benefits, including medical, dental, and vision coverage.

401(k) retirement savings plan options.

Access to industry-leading training and professional development opportunities.

Mentorship programs designed to support long-term career growth.

Opportunities to work with major healthcare clients and experienced industry professionals.

Collaborative, inclusive, and supportive team environment.

Exposure to advanced auditing technologies and complex healthcare reimbursement projects.