Required Qualifications
- 5+ years of inpatient coding, CDI, DRG validation, or clinical auditing experience
- Strong knowledge of:
- ICD-9/10 Coding
- MS-DRG, AP-DRG, and APR-DRG payment systems
- Medical claims billing and reimbursement
- Provider billing guidelines
- Payer reimbursement policies
- Recent hands-on inpatient experience required
- Nurses only need 2+ years of inpatient experience
Required Certifications
RN, LPN, or LVN with one of the following:
- CCS
- CCDS
- CDIP
- CPC
- CIC
OR
One of the following credentials:
- CCS
- RHIA
- RHIT
- CIC
- CCDS
- CDIP
Job Description
Insight Global is seeking a DRG Validation Auditor for a fully remote opportunity. This individual will review inpatient medical records to ensure coding and DRG assignment accuracy, identify reimbursement recovery opportunities, and produce high-quality audit documentation. The ideal candidate will have a strong inpatient coding, CDI, clinical auditing, or nursing background with expertise in DRG reimbursement methodologies.
Responsibilities
- Review inpatient medical records for coding and DRG accuracy
- Identify reimbursement and recovery opportunities
- Perform clinical and coding audits independently
- Create audit findings and supporting documentation
- Maintain productivity and quality standards
- Assist with process improvements and identify additional audit opportunities