Insight Global is seeking a DRG Validation Auditor for one of our clients. This role is 100% remote and focuses on auditing inpatient medical records, reviewing clinical documentation, and validating coding and DRG assignment accuracy. The position supports high-quality recoverable claims and requires strong knowledge of reimbursement guidelines and inpatient coding systems.
Key responsibilities include:
- Apply medical chart coding principles, clinical guidelines, and audit methodology to review inpatient records.
- Use advanced ICD-10 and DRG knowledge to support audit conclusions.
- Work independently using proprietary auditing systems to make determinations and generate audit letters.
- Maintain production goals, accuracy standards, and documentation quality.
- Identify additional recovery opportunities and recommend process improvements.
Requirements & Qualifications
Requirements
- 5-7+ years of experience with ICD-9/10-CM, MS-DRG, AP-DRG, and APR-DRG.
- Strong knowledge of medical claims billing/payment systems, provider billing guidelines, payer reimbursement policies, medical necessity criteria, and coding terminology.
- Expert knowledge of DRG and ICD-10 coding.
- Either:
- Registered Nurse (RN), inpatient background, with coding/clinical documentation certification and 2 years in clinical documentation, or
- RHIM, RHIA, or RHIT degree with a medical coding degree or CCS certification, plus strong clinical knowledge.
Benefits & Perks
Benefits
- Medical insurance
- Vision insurance
- Dental insurance
- 401(k)
Location
N/A
Employment Type
Full-time
Experience Level
Associate
Salary Range
$90,000 - $110,000
Remote work allowed
Yes
Posted
4 weeks ago
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