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DRG Auditor

DRG Auditor

CompanyWaystar
LocationAtlanta, GA, USA
Salary$Not Provided – $Not Provided
TypeFull-Time
Degrees
Experience LevelMid Level, Senior

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