DRG Coding Auditor - MS-DRG and APR-DRG
$92,880–$160,218 year
On-siteCosta Mesa, California, United States
Job Summary
Audit inpatient medical records and generate high-quality recoverable claims across all lines of business. Perform clinical reviews of documentation to evaluate coding and DRG assignment accuracy, integrating medical chart principles and clinical guidelines to substantiate audit determinations. Utilize audit tools and workflow systems to identify new claim types, such as re-admissions and HACs, while maintaining accuracy standards for valid claim identification. Develop process improvement recommendations to enhance efficiency and value. Requires RHIA, RHIT, CCS, CIC, or CCDS certification and five years of experience with ICD-10, MS-DRG, and APR-DRG. Salary range $92,880 - $160,218. Locations include California, Illinois, Maryland, New York, and Virginia.
Required Qualifications
- AA/AS or minimum of 5 years of experience in claims auditing, quality assurance, or recovery auditing
- RHIA certification as a Registered Health Information Administrator
- RHIT certification as a Registered Health Information Technician
- CCS as a Cert Coding Specialist
- CIC as a Certified Inpatient Coder
- Certified Clinical Documentation Specialist (CCDS)
- 5 years of experience working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG
- Virtual full-time work
- Required in-person training sessions
- Alternate locations within commuting distance from posting location(s)
- Reasonable commuting distance from posting location(s)
- COVID-19 vaccination
- Influenza vaccination
Desired Qualifications
- BA/BS preferred
- Experience with vendor based DRG Coding / Clinical Validation Audit setting or hospital coding or quality assurance environment
- Broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, billing validation criteria and coding terminology
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