DRG Validation Auditor

Job Summary

A company is looking for a DRG Validation Auditor - Contractor.

Key Responsibilities

• Validate the accuracy of ICD-10-CM, ICD-10-PCS, and DRG and APR group appropriateness for inpatient and outpatient facility claims
• Audit inpatient claims to identify potential over-assigned DRG codes to ensure accurate reimbursement
• Identify and resolve complex coding discrepancies and communicate findings to project leads and cross-functional teams

Required Qualifications

• Extensive knowledge of healthcare coding, billing, auditing, compliance, and reimbursement for inpatient and outpatient facilities
• 5 years of experience auditing facility inpatient and outpatient services with DRG and APR-DRG
• Extensive pediatric inpatient facility experience
• Proficiency in coding software, electronic health record systems, and familiarity with AI tools for coding accuracy
• Certification such as RHIA, RHIT, CCS from AHIMA or CPMA, CIC, COC from AAPC is required