Job Description

This position is listed on behalf of a partner company, which manages all applications and next steps. Our partner is looking for a DRG / Inpatient Auditor III based in the United States. We are looking for an experienced DRG / Inpatient Auditor to join a dynamic healthcare auditing environment in a fully remote capacity. In this role, you will leverage your expertise in inpatient coding, DRG reimbursement methodologies, and medical record auditing to ensure coding accuracy and identify potential reimbursement overpayments. You will conduct comprehensive MS-DRG and APR-DRG reviews, develop well-supported audit findings, and help maintain the highest standards of quality and regulatory compliance. Working with advanced coding and auditing tools, you will contribute to accurate reimbursement decisions and improved healthcare financial operations. This opportunity offers exposure to leading healthcare clients, collaboration with industry experts, and ongoing professional development. The position is 100% remote within the United States, with occasional travel of up to 10% annually. Accountabilities - Conduct comprehensive MS-DRG and APR-DRG coding audits to assess inpatient coding accuracy, validate DRG assignments, and identify potential reimbursement overpayments. - Apply advanced knowledge of ICD-10-CM/PCS coding guidelines, AHA Coding Clinic guidance, and DRG reimbursement methodologies to perform accurate and defensible reviews. - Identify, analyze, and document overpayments through retrospective DRG audits, ensuring that findings are supported by relevant coding regulations and clinical documentation. - Prepare clear, concise, and comprehensive audit reports, providing evidence-based findings and appropriate coding references. - Utilize advanced DRG encoder and auditing tools, including 3M and Webstrat, to improve audit accuracy, efficiency, and consistency. - Maintain high-quality audit outcomes by meeting established productivity and quality standards, including strong appeal uphold rates.

- Stay current with industry developments, coding updates, reimbursement policies, and healthcare compliance requirements to maintain expert-level knowledge. - Ensure strict adherence to HIPAA requirements, data security standards, and internal policies and procedures when handling confidential healthcare information. - Collaborate with colleagues and other stakeholders, contributing to knowledge sharing, continuous improvement, and consistent auditing practices. Requirements: - Minimum of a high school diploma or equivalent; additional education in healthcare, health information management, medical coding, or a related field is preferred. - At least 4 years of experience in MS-DRG and/or APR-DRG inpatient coding, with strong knowledge of AHA Coding Clinic guidelines, ICD-10-CM/PCS regulations, and DRG reimbursement methodologies. - Previous experience conducting retrospective DRG audits and identifying potential reimbursement overpayments is highly desirable. - Professional coding or health information management certification, such as CCS, CIC, CPC, RHIA, or RHIT. Multiple relevant certifications are considered an advantage. - Advanced understanding of inpatient coding principles, medical record documentation, DRG assignment, and healthcare reimbursement processes. - Strong proficiency with DRG encoder and auditing platforms, particularly 3M and Webstrat. - Excellent analytical, critical-thinking, and problem-solving abilities, with exceptional attention to detail and consistency when reviewing complex medical records. - Strong written and verbal communication skills, including the ability to produce clear, accurate, and well-supported audit documentation. - Proficiency in Microsoft Office applications, particularly Excel, Word, and OneNote, alongside strong overall computer literacy.

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