DRG Validation Auditor in Healthcare Compliance
🏢 Company: AAPC
📍 Location: USA
🌍 Remote: Yes
💼 Type: Full-time
💰 Salary: Competitive USD
📋 Overview
Remote DRG validation auditor required for healthcare provider billing. Support clinical documentation improvement and apply machine learning expertise to elevate auditing standards in medical coding and claims processes.
📝 Job Description
Job Summary
We are seeking a dedicated DRG validation auditor for a remote, US-based role. This position involves applying advanced machine learning techniques to improve provider data quality and medical coding practices. The ideal candidate will validate coding accuracy across inpatient, outpatient and pediatric facility settings, contributing to our mission of enhancing healthcare documentation and reimbursement processes.
Key Duties & Responsibilities
- Validate the accuracy of DRG/APR codes, ICD-10-CM/PCS, and CPT/HCPCS coding in claims
- Conduct inpatient claim audits to identify potential over-assignment of DRG codes
- Assist in developing and implementing clinical documentation improvement practices
- Resolve complex coding discrepancies and provide findings to project teams
- Maintain confidentiality and integrity of protected health information
- Ensure compliance with HIPAA security policies and procedures
- Collaborate with cross-functional teams including clinicians, engineers and product managers
Qualifications & Requirements
Candidates must possess comprehensive knowledge of healthcare coding and auditing principles, including:
- In-depth understanding of pediatric inpatient/outpatient coding and documentation standards
- Proficiency in ICD-10-CM, ICD-10-PCS, and DRG/APR systems for CMS and payer audits
- Experience with cost reduction strategies through accurate DRG assignment and denial coding
- Familiarity with clinical documentation improvement (CDI) processes and tools
- Expertise applying current Official Coding Guidelines and Coding Clinic citations
Key Attributes
Candidates should demonstrate:
- Meticulous attention to detail and deadline management skills
- Critical thinking abilities for analyzing complex coding scenarios
- Excellent organizational capabilities and a proactive methodology
Preferred Skills
Advanced proficiency with:
- Coding and compliance software platforms
- Electronic health record (EHR) systems
- AI/ML tools for coding validation and DRG optimization
✅ Qualifications
- Comprehensive background in healthcare coding, billing, auditing, compliance and reimbursement across inpatient and outpatient settings
- 5+ years of experience auditing facility services, including proficiency with DRG and APR-DRG systems
- Proven expertise in clinical documentation improvement practices
- Demonstrable knowledge of current Official Coding Guidelines and Coding Clinic resources
- Substantial experience reducing claim denials through precise DRG assignment and claim analysis
- Technical proficiency with coding and compliance software, including experience with AI/ML tools
- Strong foundation in anatomical, physiological, pathological, and pharmacological principles
- RHIA, RHIT, CCS, CPMA, CIC, or COC certifications preferred
- Proven ability to manage high-volume auditing projects with accuracy and efficiency
- Detailed understanding of pediatric healthcare coding requirements
- Adherence to all regulatory requirements including HIPAA compliance
🎁 Benefits
Direct application link to company career page
🔖 Tags: None
📱 Follow us: Telegram | LinkedIn
Source: Curated from public job boards. Verify details on the employer site before applying.
