DRG Auditor

DRG Auditor

Requirements

• Self-sufficient with strong analytical and research skills
• In depth knowledge related to coding hospital inpatient record types, clinical documentation, payer reimbursement methodology, medical necessity criteria, billing requirements and applicable industry based standards
• Remain current on ICD and CPT/ HCPC coding requirements
• Proficient with Microsoft Office products and possess the ability to work effectively with computerized programs and databases
• Ability to communicate effectively
• Demonstrate independent judgment, discretion, and decision making abilities
• Self-motivated, hardworking individual with a high attention to detail
• Excellent organization skills

Responsibilities

• Achieve and maintain assigned client financial performance goals
• Validate code and DRG assignment and supporting clinical documentation based on physician documentation, UHDDS guidelines and official coding guidelines using proprietary technology and medical records
• Assist in prediction enhancements to increase verification rates

Preferred Qualifications

• 3+ years of inpatient auditing/coding experience with ICD and CPT/HCPCS
• Experience working within the hospital environment preferred
• Experience in MS-DRG validation, APR-DRG validation and clinical validation
• Experience related to PSI, HAC, and other quality metrics is a plus
• CCS, CPC, RHIT, RHIA, CDIP, CCDS or other coding/clinical certifications, credentials, or expertise preferred