Remote DRG Auditor (RN)

MUST HAVES

• Certified Coding Specialist (CCS)
• 5+ years of experience in third-party DRG auditing/CDI auditing
• Experience with inpatient coding
• Experience reviewing/challenging “high dollar claims”
• This is a candidate who has successfully disputed DRG assignments in the final stages and validated claims for reimbursement accuracy, particularly in complex, high-dollar cases

PLUSSES

• RN license or BSN OR RHIT/RHIA

ROLE OVERVIEW:

Insight Global is seeking experienced DRG Auditors to join a remote healthcare organization. The DRG Revenue Integrity Auditor will work closely with physicians to perform DRG validation and quality audits on inpatient charts to ensure accurate coding and compliance with federal regulations. This is a remote opportunity, and the salary for this role is 95-115k based on the candidate’s years of experience.

DAY TO DAY:

• Conduct thorough chart reviews to validate that assigned codes accurately reflect the patient’s clinical picture.
• Utilize ICD-10-CM and ICD-10-PCS coding systems to ensure proper code sequencing and accuracy.
• Validate Present on Admission (POA) indicators, Severity of Illness (SOI), Risk of Mortality (ROM), Hierarchical Condition Category (HCC) capture, Case Mix Index (CMI), and other coding factors.
• Apply current clinical criteria, including MCG, InterQual, payer clinical policy bulletins, CMS guidelines, NCDs, and LCDs.
• Adhere to coding guidelines and Clinical Documentation Improvement (CDI) best practices as endorsed by ACDIS and AHIMA.
• Compose and send queries when documentation is insufficient or unclear.
• Identify query opportunities and ensure accurate code assignment and sequencing.
• Maintain high-quality standards in chart reviews to accurately reflect the patient’s condition.
• Stay current with medical coding guidelines and industry developments.
• Assist in developing training materials and provide onboarding support to new hires.
• Support project data analysis, reporting, and feedback for internal teams and external clients.
• Maintain professional conduct and ensure the confidentiality of Protected Health Information (PHI).
• May be asked to audit clients’ CDI programs, including query reviews and coding analysis.
• Responsible for maintaining access credentials for company systems and EMRs.

Pay: $95,000.00 – $115,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Flexible schedule
• Health insurance
• Paid time off
• Vision insurance

Work Location: Remote