DRG Auditor - Revenue Integrity

• Achieve and maintain assigned client financial performance goals 

• Validate code and DRG assignment and supporting clinical documentation based on physician documentation, UHDDS guidelines and official coding guidelines using proprietary technology and medical records 

• Assist in prediction enhancements to increase verification rates 

• Self-sufficient with strong analytical and research skills 

• In depth knowledge related to coding hospital inpatient record types, clinical documentation, payer reimbursement methodology, medical necessity criteria, billing requirements and applicable industry based standards 

• Remain current on ICD and CPT/ HCPC coding requirements  

• Proficient with  Microsoft Office products and possess the ability to work effectively with computerized programs and databases 

• Ability to communicate effectively  

• Demonstrate independent judgment, discretion, and decision making abilities 

• Self-motivated, hardworking individual with a high attention to detail  

• Excellent organization skills 

Experience 

• 3+ years of inpatient auditing/coding experience with ICD and CPT/HCPCS 

• Experience working within the hospital environment preferred 

• Experience in MS-DRG validation, APR-DRG validation and clinical validation 

• Experience related to PSI, HAC, and other quality metrics is a plus 

Education/Certification 

• CCS, CPC, RHIT, RHIA, CDIP, CCDS or other coding/clinical certifications, credentials, or expertise preferred