CDI-DRG Validation Auditor
AAPC
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteJob Level
Mid-LevelSenior
About the role
- 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.
Requirements
- Extensive knowledge of healthcare industry and experience in and around coding, billing, auditing, compliance and reimbursement for Inpatient and Outpatient facility.
- Must have extensive pediatric inpatient facility experience.
- Strong knowledge of clinical indicators, diagnostic criteria, and evidence-based guidelines to support accurate code assignment.
- 5 years of CDI expertise in facility inpatient and outpatient services with DRG and APR-DRG as well as familiarity with clinical documentation improvement practices.
- Extensive knowledge of current Official Coding Guidelines and Coding Clinic citations.
- Strong background in cost reduction strategies by ensuring correct claims payment and appropriate diagnosis-related group (DRG) assignment including familiarity with inpatient denial coding systems (e.g. CARC codes).
- Proficiency in coding software, electronic health record systems and familiar with how AI tools can assist in identifying over/under-assigned DRGs.
- Experience in working with technical teams building coding and large language models.
- High level proficiency in anatomy, physiology, disease process, and pharmacology.
- Detail oriented and deadline driven attitude.
- Ability to think critically and determine the best method for resolving challenges.
- Strong organizational skills, a strong sense of accountability, a proactive work ethic.
Benefits
- Comprehensive benefits package including medical, dental and vision insurance
- Health Savings Account
- Generous PTO and Holiday Pay
- 401(k) retirement plan
- Remote/virtual-office consideration
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
ICD-10-CMICD-10-PCSCPTHCPCSDRGAPR-DRGclinical documentation improvementcoding guidelinescost reduction strategiesanatomy
Soft skills
detail orienteddeadline drivencritical thinkingorganizational skillsaccountabilityproactive work ethiccommunicationproblem solvingcollaborationconfidentiality