AAPC

Auditor

• 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

AAPC

DRG Validation Auditor

Customer Care Supervisor