The DRG Coding Auditor position has an extensive background in facility-based coding practices, clinical documentation, and/or inpatient coding auditing. This person should have a high level of understanding of reimbursement guidelines, specifically around the billing practices using MS-DRG, APR-DRG, and Itemized Bill Reviews (IBR). This position is responsible for auditing inpatient medical records to evaluate issues of coding and DRG assignment accuracy to generate high quality recoverable claims for the benefit of our clients.

YOU MAY BE IDEAL IF YOU HAVE

• 3+ years of performing inpatient acute care hospital coding (may substitute equivalent years of DRG validation experience) OR 3+ years of Clinical Documentation Improvement experience (coding OR auditing)
• CCS or CIC certification.
• Experience with ICD-10 CM and DRG coding.
• Positive, self-motivated, driven, and teachable attitude.
• High standard of personal integrity and accountability.
• Passion and aptitude for solving complex problems.
• Fun attitude and great sense of humor!

The essential functions include, but are not limited to, the following:

• Investigate, review, and provide coding expertise in the application of medical and reimbursement policies within the claim adjudication process through document review.
• Perform clinical coverage review of claims, which requires interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies, coding requirements and consideration of relevant clinical information on claims with aberrant billing patterns.
• Perform clinical coding review to ensure accuracy of medical coding and utilize clinical expertise and judgment to determine correct coding and billing.
• Knowledge of and the ability to: identify the ICD-10-CM/PCS code assignment, code sequencing, and discharge disposition, in accordance with CMS requirements, Official Guidelines for Coding and Reporting, and Coding Clinic guidance.
• Must be fluent in application of current Official Coding Guidelines and Coding Clinic citations, in addition to demonstrating working knowledge of clinical criteria documentation requirements used to successfully substantiate code assignments.
• Solid command of anatomy and physiology, diagnostic procedures, and surgical operations developed from specialized training and extensive experience with ICD-10-PCS code assignment.
• Writes clear, accurate and concise rationales in support of findings.
• Maintain and manage daily case review assignments, with a high emphasis on quality.
• Provide clinical support and expertise to the other investigative and analytical areas.
• Will be working in a high-volume production environment.

Closing

This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give instructions or assignments. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise, other than an “at-will” relationship. The company is an Equal Opportunity Employer, drug-free workplace, and complies with ADA regulations as applicable.