DRG Revenue Integrity Auditor

About Us

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.

Job Summary

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 will 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 will utilize International Classification of Diseases - Clinical Modification (CM) and Procedure Coding System (PCS) Terminology to ensure accurate coding.

Responsibilities

• Utilize most current Clinical Criteria, MCG, InterQual, payers’ Clinical Policy Bulletins, CMS Guidelines, NCDs and/or LCDs.
• Adhere to all coding guidelines and CDI best practices, as endorsed by ACDIS and AHIMA, to determine correct coding that is clinically supported and compose and send queries when necessary.
• Analyze records for potential query opportunities and appropriate code assignment along with correct code sequencing.
• Maintain quality of reviews by making sure the true clinical picture is captured timely.
• Stay up to date with medical and coding guidelines, along with advancements within their field.
• Support CorroHealth in developing accurate training materials.
• Provide training and shadowing to new hires.
• Aid CorroHealth with project data analysis, reporting, and feedback internally and externally to CorroHealth clients.
• Maintain professional etiquette. Ensure all PHI is appropriately stored and delivered to authorized individuals.
• Met or exceed production and quality metrics.
• Attend all mandatory meetings and trainings.
• Additionally, DRG - A may also be required to audit clients’ clinical documentation integrity (CDI) program to include query review, analysis of coding, and overall program accuracy.
• Responsible to keep up with your company and EMR access log ins and passwords.
• All other position related duties as delegated by management.

Requirements

• 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 of working as a CDI/Coding auditor is preferred but NOT a requirement.

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.
• Works well with numbers, 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.