Inpatient Coding Auditor - DRG Validation

Job Title: Inpatient Coding Auditor - DRG Validation
Location: Remote
Salary: $33.00 – $50.00 per hour
Schedule: Full-time
Travel: Initial onsite orientation during the first week with occasional additional travel as needed

Job Overview:
We are seeking an experienced Inpatient Coding Auditor specializing in DRG validation to review medical records and ensure the accuracy of Diagnosis Related Group assignments. This role focuses on validating inpatient coding, evaluating clinical documentation, and ensuring compliance with CMS regulations and coding guidelines.

The ideal candidate has strong inpatient coding experience, deep knowledge of DRG assignment, and the ability to analyze clinical documentation to ensure accurate coding and reimbursement.

Key Responsibilities:

• Review inpatient medical records to validate accurate DRG assignment and coding compliance
• Analyze patient charts to identify discrepancies in coding or clinical documentation
• Ensure coding accuracy according to CMS regulations and industry coding guidelines
• Conduct second-level reviews of DRGs, discharge dispositions, and Present on Admission (POA) indicators prior to billing
• Collaborate with coding teams and clinical staff to resolve documentation and coding questions
• Participate in coding audits and quality improvement initiatives
• Research and respond to coding or documentation denials related to DRG assignments
• Provide guidance and education to coding staff regarding documentation and coding best practices
• Support regulatory compliance and internal audit activities

Required Qualifications:

• Minimum of 5 years of inpatient coding experience
• Experience with DRG validation, auditing, or coding quality review
• Strong understanding of clinical documentation and coding compliance standards
• Ability to work independently in a remote environment
• Strong analytical and communication skills

Education:

• Associate's or Bachelor's degree in Health Information Management or a related field preferred

Required Certification:Candidates must hold at least one of the following credentials:

• RHIA
• RHIT
• CCS
• CPC
• CCS-P

Technical Knowledge:

• Strong understanding of DRG assignment and coding guidelines
• Familiarity with UB-04 billing standards and CMS regulations
• Experience reviewing clinical documentation for coding accuracy

Benefits:

• Competitive hourly compensation
• Comprehensive medical, dental, and vision coverage
• Three weeks of paid vacation
• Fully remote work environment
• Opportunity to work in a specialized coding and compliance role within healthcare operations

Originally posted on Himalayas