Patient Safety DRG Coding Auditor Principal
Core
Auditing inpatient medical records on claims paid based on Diagnostic Relation Group (DRG) methodology to generate complex audit findings and recoverable claims for the company and its clients.
Role type
Principal DRG Coding Auditor
Builds
Recoverable claims and audit findings letters for complex DRG cases (APS-DRG, APR-DRG, AP-DRG, MS-DRG, TRICARE)
Domain
Healthcare / Medical Claims Auditing
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
ICD-10 coding expertise, DRG methodology knowledge (MS-DRG, APR-DRG, AP-DRG, TRICARE), medical record auditing, clinical guidelines interpretation, audit tool utilization, process improvement, secondary audit review
Preferred skills
Vendor-based DRG coding audit experience, hospital coding environment experience, payer reimbursement policy knowledge, AI tool utilization for verification
Technologies
Audit tools, workflow systems, ICD-10 Alphabetic and Tabular Indices
Responsibilities
Analyze and audit claims integrating advanced medical chart coding principles; substantiate sophisticated conclusions using clinical guidelines; generate audit findings letters; validate accuracy and quality standards for lower-level auditors; identify new claim types (re-admissions, HACs, PAEs); suggest process improvement recommendations; perform secondary audits on claims reviewed by other coders
Seniority
Principal, high-level individual contributor with autonomy