Auditor

• Auditing inpatient medical records on claims paid based on Diagnostic Relation Group (DRG) methodology, including case rate and per diem
• Generating highly complex audit findings recoverable claims for the benefit of the Company
• Specializes in review of DRG coding via medical record and attending physician’s statement provided by acute care hospitals on paid DRG
• Analyzing and auditing claims by integrating advanced or convoluted medical chart coding principles
• Utilizing audit tools and auditing workflow systems and reference information to make audit determinations and generate audit findings letters
• Validating accuracy and quality standards as set by audit management for auditing concept, valid claim identification, and documentation purposes
• Identifying new claim types by identifying potential claims outside of the concept where additional recoveries may be available
• Suggesting and developing high quality concept and or process improvement recommendations
• Performing secondary audits on claims that have been reviewed by other DRG Coders for missed opportunities

Principal DRG Coding Auditor

IT Internal Auditor – Senior Associate

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Staff Auditor

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