AAPC

Auditor

• Review hospital records for clinical supports to validate the accuracy of ICD-10-CM, ICD-10-PCS, and DRG and APR group appropriateness, CPT and HCPCS inpatient patient and outpatient facility claims.
• Identify codes that may have been over or under assigned, ensuring accurate reimbursement aligned with regulatory and contractual guidelines.
• Identify and resolve complex coding discrepancies.
• Write technical rationales for correct clinical, documentation and code changes.
• Communicate complex coding findings to project lead and other cross functional teams.
• Be responsible and accountable for maintaining confidentiality, integrity, and availability of protected health information.
• Follow HIPAA security policies and procedures affecting your job, and report any suspected or actual violation or breach.

CDI-DRG Validation Auditor

Project Manager

• Assists with the logistics of onboarding new clients
• Support monthly invoicing of services and assist management team in daily office activities
• Coordinates new client on boarding kick off calls, including setting up accounts for audits, coding and invoicing, coordinator project plans and EMR accesses
• Communicates regularly with clients including performing follow-up on EMR accesses, project schedules and uploading of medical record information, sending project reports / deliverables, scheduling meetings and education calls and solve for problems that may arise
• Attend daily operational meeting to report status of projects
• Keep internal reporting and tracking tools up to date to ensure accurate information for invoicing clients and performance monitoring
• Serve as a backup for monthly invoicing
• Perform miscellaneous office duties as assigned

Project Coordinator

• Validate the accuracy of ICD-10-CM, ICD-10-PCS, and DRG and APR group appropriateness, CPT and HCPCS inpatient patient and outpatient facility claims
• Audit inpatient claims to identify DRG codes that may have been over-assigned, ensuring accurate reimbursement aligned with regulatory and contractual guidelines
• Identify and resolve complex coding discrepancies
• Write technical rationales for correct documentation and code changes
• Communicate complex coding findings to project lead and other cross functional teams (clinicians, engineers, product managers)
• Apply state-of-the-art machine learning software to improve the data quality and medical coding practices of providers and inform next-generation auditing software
• Be responsible and accountable for maintaining confidentiality, integrity, and availability of protected health information; follow HIPAA security policies and report suspected or actual violations or breaches
• Adhere to project deadlines and variable expected work volumes depending upon projects

CDI-DRG Validation Auditor

Project Coordinator

DRG Validation Auditor

Customer Care Supervisor