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 medical records. This role ensures coded data accurately reflects the patient’s clinical picture and complies with federal regulations. The Auditor reviews ICD‑10‑CM/PCS code assignment, POA indicators, SOI/ROM, HCC capture, case mix index (CMI), and related coding elements to support correct reimbursement.The Auditor applies current clinical criteria (e.g., MCG, InterQual), payer clinical policy bulletins, CMS guidelines, NCDs/LCDs, and official coding guidelines. The role may also participate in CDI program audits, assess query opportunities, and support both internal and client‑facing reporting. The Auditor maintains high standards of accuracy, productivity, and professional conduct while protecting patient and client confidentiality.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.
Coding & DRG Audit Responsibilities
Perform DRG validation and quality audits on inpatient charts.
Validate sequencing and accuracy of ICD‑10‑CM/PCS codes, POA status, SOI/ROM, HCC capture, and other coding factors.
Ensure coded data aligns with federal regulations and organizational standards.
Analyze charts for potential query opportunities and confirm correct coding and sequencing.
Perform audits of client Clinical Documentation Integrity (CDI) programs when assigned.
Maintain timely and accurate reviews to ensure the true clinical picture is captured.
Compliance & Clinical Standards
Follow all official coding guidelines, AHIMA Standards of Ethical Coding, and CDI best practices endorsed by ACDIS/AHIMA.
Apply current clinical criteria (e.g., MCG, InterQual), payer bulletins, and CMS regulatory guidance.
Stay up to date on changes in clinical guidance, coding clinics, and coding regulations.
Training, Education & Support
Provide training, shadowing, and support for new hires when requested.
Assist in developing training materials and updates to clinical, coding, and CDI policies.
Support internal and external project data analysis, reporting, and feedback.
Professional Conduct & Communication
Maintain strict confidentiality of PHI and client information at all times.
Communicate with coworkers professionally, promoting teamwork and knowledge sharing.
Demonstrate strong relationship‑building and communication skills in client interactions.
Productivity & Quality
Meet or exceed assigned productivity and accuracy metrics for each project or record type.
Ensure production standards are consistently achieved while maintaining high‑quality reviews.
Participate in mandatory meetings, trainings, and continuing education activities.
Other Responsibilities
Maintain company and EMR access credentials and comply with security requirements.
Perform additional duties as assigned by management.
MINIMUM QUALIFICATIONS & REQUIREMENTS:
Required: Five or more years of experience in an acute care setting or third‑party vendor as a DRG Auditor or Clinical Documentation Specialist (CDS).
Preferred: Prior experience as a CDI or coding auditor (not required).
Experience working remotely and with electronic medical record (EMR) systems.
Proficiency with MS Word, Excel, Outlook, Teams, and other standard software.
Strong analytical skills and comfort working with numerical data.
Ability to manage multiple diverse clients and switch between projects as needed.
Strong teamwork orientation and ability to work effectively with minimal supervision.
Ability to maintain and organize multiple files and work in a fast‑paced environment.
PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described.
Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.
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