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DRG Auditor – Revenue Integrity
CisionRevenue Integrity DRG Auditor performing inpatient coding and financial analysis reviews at Waystar. Working independently to validate coding and enhance verification rates while ensuring compliance with industry standards.
About the role
Key responsibilities & impact- Achieve and maintain assigned client financial performance goals
- Validate code and DRG assignment and supporting clinical documentation based on physician documentation, UHDDS guidelines and official coding guidelines using proprietary technology and medical records
- Assist in prediction enhancements to increase verification rates
Requirements
What you’ll need- 3+ years of inpatient auditing/coding experience with ICD and CPT/HCPCS
- Experience working within the hospital environment preferred
- Experience in MS-DRG validation, APR-DRG validation and clinical validation
- Experience related to PSI, HAC, and other quality metrics is a plus
- Self-sufficient with strong analytical and research skills
- In depth knowledge related to coding hospital inpatient record types, clinical documentation, payer reimbursement methodology, medical necessity criteria, billing requirements and applicable industry based standards
- Remain current on ICD and CPT/HCPC coding requirements
- Proficient with Microsoft Office products and possess the ability to work effectively with computerized programs and databases
- Ability to communicate effectively
- Demonstrate independent judgment, discretion, and decision making abilities
- Self-motivated, hardworking individual with a high attention to detail
- Excellent organization skills
Benefits
Comp & perks- Competitive total rewards (base salary + bonus, if applicable)
- Customizable benefits package (3 medical plans with Health Saving Account company match)
- Generous paid time off for our non-exempt team members, starting with 3 weeks + 13 paid holidays, including 2 personal floating holidays
- Flexible time off for our exempt team members + 13 paid holidays
- Paid parental leave (including maternity + paternity leave)
- Education assistance opportunities and free LinkedIn Learning access
- Free mental health and family planning programs, including adoption assistance and fertility support
- 401(K) program with company match
- Pet insurance
- Employee resource groups
ATS Keywords
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Hard Skills & Tools
inpatient auditingICD codingCPT codingHCPCS codingMS-DRG validationAPR-DRG validationclinical validationcoding hospital inpatient record typespayer reimbursement methodologybilling requirements
Soft Skills
analytical skillsresearch skillseffective communicationindependent judgmentdiscretiondecision makingself-motivatedattention to detailorganization skills