DRG Auditor (REMOTE)
Core
Review post-billed inpatient claims to identify and validate missed reimbursement opportunities based on diagnosis and procedure coding.
Role type
DRG auditor / medical coding specialist
Builds
Optimized hospital reimbursement and accurate DRG grouping
Domain
Healthcare revenue cycle management / medical coding
Deliverable
production ML models | product features | dashboards & analysis | client delivery
Required skills
ICD-10-CM/PCS coding, DRG reimbursement methodology, medical record review, clinical documentation analysis, billing database navigation, error identification, reimbursement optimization
Preferred skills
RHIT or RHIA credentialing, Health ROI system usage, high-volume data processing
Technologies
ICD-10-CM/PCS, DRG grouping software, EMRs, Health ROI system, MS Office
Responsibilities
Review inpatient claims for diagnosis and procedure coding accuracy; Analyze weekly hospital billing files to identify underpaid claims; Conduct detailed medical record reviews post-bill; Match clinical documentation to ICD-10 codes; Identify and correct coding errors; Make reimbursement improvement recommendations; Collaborate on case prioritization and workflow management; Stay informed on coding updates and payer guidelines.
Seniority
Mid-level, hands-on specialist