Remote DRG Validation Auditor specializing in Pediatric Healthcare Coding
🏢 Company: AAPC
📍 Location: USA
🌍 Remote: Yes
💼 Type: Contract
💰 Salary: Not specified
📋 Overview
Remote auditing role auditing facility claims, ensuring correct coding and accurate DRG/APR-DRG assignments, improving data quality through AI tools, requires pediatric coding expertise.
📝 Job Description
Responsibilities
- Validate accuracy of clinical documentation, coding, and DRG assignment for inpatient and outpatient claims.
- Conduct audits to identify and resolve discrepancies, ensuring regulatory compliance and accurate reimbursement.
- Analyze patient data to ensure correct DRG/Grouper assignment to prevent over/under payment.
- Identify cost-saving opportunities through optimal coding practices.
- Collaborate with cross-functional teams using advanced AI/ML tools.
- Communicate audit findings effectively to project stakeholders.
Target Audience
We’re seeking experienced individuals within AAPC, a trusted leader in healthcare services, who excel in meticulousness, possess extensive pediatric coding knowledge, and thrive in collaborative, high-impact environments focused on enhancing coding data quality and outcomes.
Skilled in
- ICD-10-CM, ICD-10-PCS, MS-DRG, APR-DRG, and CPT/HCPCS coding systems.
- Pediatric healthcare coding principles and accuracy requirements.
- Healthcare compliance regulations including HIPAA.
- AI/ML software for data quality improvement.
- Adapting to evolving industry standards and guidelines.
✅ Qualifications
- Substantial background in health information management and coding, with emphasis on pediatric services.
- Proven experience auditing and analyzing inpatient and outpatient claims, achieving DRG/APR-DRG accuracy.
- 5+ years dedicated to healthcare coding and auditing, demonstrating expertise in payer claim processes.
- Comprehensive understanding of and adherence to all Official Coding Guidelines and Coding Clinics updates.
- Knowledge of industry-specific coding denial factors (including familiarity with codes like CARC).
- Mastery of standard coding software, EHR systems, and creative integration with AI tools.
- Solid comprehension of anatomical, physiological, pharmacological principles and disease processes.
- Strong analytical and problem-solving skills focused on ambiguity in medical data.
- Excellent organizational abilities, high attention to detail, and commitment to deadlines and accountability.
🎁 Benefits
Direct application link to company career page
🔖 Tags: None
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Source: Curated from public job boards. Verify details on the employer site before applying.
