Medical Coding Auditor

Our company is searching for a Remote DRG Coding Auditor to join our client's team, performing in-depth documentation and coding audits for our healthcare clients. In this audit-focused role, you'll conduct independent reviews of inpatient medical records, evaluating the accuracy of diagnosis and procedure codes to ensure optimal reimbursement and compliance with official guidelines, regulatory requirements, and ethical standards. Leveraging your deep knowledge of DRG payment systems (such as MS, APR, and Tricare), you'll assess coding accuracy, documentation integrity, and identify opportunities for coder education and documentation improvement. This is a fully remote position and you can live anywhere within the US.

Hours: Monday - Friday 8am - 5pm EST with some flexibility within the daily hours by about 2-3 hours

Responsibilities for the position include the following:

• Perform comprehensive audits of all acute inpatient medical records to identify coding errors, compliance concerns, and educational opportunities.
• Interpret, evaluate, and apply ICD-10-CM/PCS coding principles and guidelines to ensure documentation adequately supports the coded diagnoses and procedures.
• Verify that assigned DRGs accurately reflect patient severity and resource utilization according to MS, APR, Tricare, and related payment methodologies.
• Research regulatory requirements and provide clear, well-supported recommendations in audit reports.
• Collaborate with Clinical Documentation Integrity (CDI) specialists to pinpoint and communicate documentation and/or physician query opportunities.
• Write concise, constructive feedback and educational notes for coders, referencing the latest official coding guidelines and AHA Coding Clinics.
• Maintain established productivity and quality standards as measured by audit leadership.

Requirements:

• Minimum of 5 years of recent coding experience required.
• At least 3 years of acute inpatient/facility coding audit experience required.
• Active CIC (Certified Inpatient Coder) certification.
• Deep knowledge of DRG payment and reimbursement systems (MS-DRG, APR-DRG, Tricare, etc.).
• Proven ability to independently interpret complex medical records, identify documentation gaps, and communicate required improvements.
• Strong written and verbal communication skills.