DRG Revenue Integrity Auditor
NACBA, Johns Creek, GA, United States
The DRG Revenue Integrity Auditor (DRG - A) performs Diagnostic Related Group (DRG) validation and quality audits on inpatient charts. The DRG - A will perform chart reviews and ensure that all reviewed charts capture the patient’s true clinical picture from the codes assigned by the facility’s coders in compliance with federal laws. The DRG - A utilizes the International Classification of Diseases - Clinical Modification (ICD-10-CM) and Procedure Coding System (PCS) Terminology to ensure accurate coding. The role is responsible for validating proper sequencing and accuracy of ICD‑10‑CM/PCS codes, POA assignments, severity of illness (SOI), risk of mortality (ROM), Hierarchical Condition Category (HCC) capture, CMI, and other coding factors. It uses current Clinical Criteria, MCG, InterQual, payers’ Clinical Policy Bulletins, CMS Guidelines, NCDs and/or LCDs. The auditor adheres to all coding guidelines and CDI best practices, as endorsed by ACDIS and AHIMA, to determine correct coding that is clinically supported and composes and sends queries when necessary. The auditor analyzes records for potential query opportunities and appropriate code assignments along with correct code sequencing. The auditor maintains quality of reviews by ensuring the true clinical picture is captured in a timely manner, stays up to date with medical and coding guidelines together with advancements within their field, supports CorroHealth in developing accurate training materials, provides training and shadowing to new hires, assists with project data analysis, reporting, and feedback internally and externally to CorroHealth clients, and maintains professional etiquette. The auditor ensures all PHI is appropriately stored and delivered to authorized individuals, meets or exceeds production and quality metrics, and attends all mandatory meetings and trainings. Additionally, the DRG - A may be required to audit clients’ clinical documentation integrity (CDI) program to include query review, analysis of coding, and overall program accuracy. The auditor is responsible for keeping up with the company’s EMR access log ins and passwords and any other duties delegated by management. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The list below represents the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Sign on bonus available
Important Duties and Responsibilities
Adherence to all coding guidelines and CDI best practices, as endorsed by ACDIS and AHIMA, to determine correct coding that is clinically supported
Analyze records for potential query opportunities and appropriate code assignment and code sequencing
Maintain quality of reviews and ensure the true clinical picture is captured, along with ensuring chart review productivity
Stay up to date with official coding guidelines, coding clinics and clinical criteria
Provide training to other new hires, if required, and support development of training materials, as well as clinical, coding and CDI policies
Assist with project data analysis, reporting, and feedback both internally and to clients
Protect privacy and confidentiality of patient health and client information, and follow the Standards of Ethical Coding as set forth by AHIMA and adhere to official coding guidelines, compliance practices, standards, and procedures
Conduct chart reviews as assigned, meeting the productivity standards as set forth for each project or record type
Communicate with coworkers in an open and respectful manner that promotes teamwork and knowledge sharing
Interact with clients in a professional manner, exhibiting excellent relationship, work performance and communication skills to support the company and its business interests
Maintain professional credentials and knowledge of CDI, coding, reimbursement, and compliance issues through continuing education
Other duties and responsibilities as assigned
Work Experience
CCS required
Five or more years working in an acute care setting or a third‑party vendor as a DRG auditor or Clinical Documentation Specialist (CDS)
Prior experience working as a CDI/Coding auditor is preferred but not required
Knowledge, Skills & Abilities
Experience with telecommuting and electronic medical record systems required
Good computer skills and familiarity with commonly used work apps, such as MS Word, MS Excel, MS Outlook, Teams, etc.
Strong analytical skills
Number proficiency, using basic math skills
Strong team player
Ability to work with multiple and diverse clients and projects
Ability to switch between multiple clients throughout the day and week
Ability to work with minimal supervision
Ability to maintain and access multiple files
We Offer
Quality of life with a remote predictable, full‑time schedule
Exempt/salaried positions
Opportunities for career growth within the organization
Medical, dental, vision coverage, 401(k) with match
Long‑term disability insurance, life insurance and more
Holidays, time and ample paid time off
Allowance for CME and/or license renewal
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Sign on bonus available
Important Duties and Responsibilities
Adherence to all coding guidelines and CDI best practices, as endorsed by ACDIS and AHIMA, to determine correct coding that is clinically supported
Analyze records for potential query opportunities and appropriate code assignment and code sequencing
Maintain quality of reviews and ensure the true clinical picture is captured, along with ensuring chart review productivity
Stay up to date with official coding guidelines, coding clinics and clinical criteria
Provide training to other new hires, if required, and support development of training materials, as well as clinical, coding and CDI policies
Assist with project data analysis, reporting, and feedback both internally and to clients
Protect privacy and confidentiality of patient health and client information, and follow the Standards of Ethical Coding as set forth by AHIMA and adhere to official coding guidelines, compliance practices, standards, and procedures
Conduct chart reviews as assigned, meeting the productivity standards as set forth for each project or record type
Communicate with coworkers in an open and respectful manner that promotes teamwork and knowledge sharing
Interact with clients in a professional manner, exhibiting excellent relationship, work performance and communication skills to support the company and its business interests
Maintain professional credentials and knowledge of CDI, coding, reimbursement, and compliance issues through continuing education
Other duties and responsibilities as assigned
Work Experience
CCS required
Five or more years working in an acute care setting or a third‑party vendor as a DRG auditor or Clinical Documentation Specialist (CDS)
Prior experience working as a CDI/Coding auditor is preferred but not required
Knowledge, Skills & Abilities
Experience with telecommuting and electronic medical record systems required
Good computer skills and familiarity with commonly used work apps, such as MS Word, MS Excel, MS Outlook, Teams, etc.
Strong analytical skills
Number proficiency, using basic math skills
Strong team player
Ability to work with multiple and diverse clients and projects
Ability to switch between multiple clients throughout the day and week
Ability to work with minimal supervision
Ability to maintain and access multiple files
We Offer
Quality of life with a remote predictable, full‑time schedule
Exempt/salaried positions
Opportunities for career growth within the organization
Medical, dental, vision coverage, 401(k) with match
Long‑term disability insurance, life insurance and more
Holidays, time and ample paid time off
Allowance for CME and/or license renewal
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