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DRG Auditor
EnableCompDRG Auditor validating inpatient coding and reimbursement opportunities for EnableComp’s healthcare revenue-cycle solutions. Reviewing medical records, ICD-10 codes, DRG data, and hospital billing files remotely.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in DRG validation and inpatient medical coding, with a strong understanding of ICD-10-CM/PCS coding guidelines and DRG reimbursement methodology. Proficient in analyzing medical and billing data while ensuring compliance with privacy standards.
Highest-signal resume keywords
Certified Coding Specialist (CCS)ICD-10-CM/PCS Coding GuidelinesDRG ValidationInpatient Medical CodingHealth Information Management
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
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Hard Skills
DRG ValidationInpatient Medical CodingICD-10-CM/PCS CodingData AnalysisReimbursement Improvement RecommendationsClinical Documentation ReviewBilling ProcessesCoding Accuracy AssessmentHigh-Volume Data ManagementPost-Bill Coding Experience
Soft Skills
Attention to DetailAnalytical SkillsProblem-SolvingCommunication SkillsProject Management
Tools & Technologies
Health ROI SystemDRG Grouping SoftwareEMRsMS OfficeDigital Platforms
Certifications & Qualifications
Certified Coding Specialist (CCS)
Industry Keywords
DRG Reimbursement MethodologyHospital Billing ProcessesClinical DocumentationPHI HandlingConfidential Information Management
About the role
Key responsibilities & impact- Review inpatient claims in the DRG database for diagnosis, procedures, grouping logic, and reimbursement accuracy
- Analyze weekly hospital billing files to identify underpaid claims
- Conduct post-bill medical record reviews to assess diagnosis and procedure coding accuracy and completeness
- Navigate medical records and review targeted sections such as discharge summaries and operative reports
- Match clinical documentation to ICD-10 codes and validate DRG accuracy
- Identify and correct undercoded or misclassified diagnoses and procedures
- Use Health ROI system edits to identify high-value reimbursement opportunities
- Prepare reimbursement improvement recommendations for client review and approval
- Collaborate with leadership on case prioritization and workflow management
- Monitor coding updates, payer guidelines, and DRG changes
- Analyze client reporting and identify new inpatient DRG-related revenue opportunities
- Handle PHI and confidential proprietary information with strict privacy and security
Requirements
What you’ll need- Associate's or bachelor’s degree in health information management or related field required
- Certified Coding Specialist (CCS) certification required
- 2–3 years’ experience in DRG validation, inpatient medical coding, or related coding review
- Strong understanding of ICD-10-CM/PCS coding guidelines
- Understanding of DRG reimbursement methodology and hospital billing processes
- Ability to read and interpret clinical documentation across nursing, operative, radiology, and pharmacy departments
- Experience in a post-bill coding environment
- Familiarity with DRG grouping software and billing databases
- Proficiency navigating digital platforms, EMRs, and data systems
- Strong computer proficiency and knowledge of MS Office, including Word, Excel, and Outlook
- Ability to work independently in a detail-oriented, data-driven environment
- Excellent communication and documentation skills
- High integrity and professionalism when handling PHI and confidential information
- Ability to analyze large volumes of medical and billing data
- Strong attention to detail, analytical, problem-solving, prioritization, and project-management skills
- Experience with external clients, customer service skills, and business acumen
- Ability to meet deadlines and manage high-volume, time-sensitive workloads
- Timely and regular attendance
Benefits
Comp & perks- Full-time employment
- Remote work option
- Professional growth and development
- Tools, resources, and support for career growth
- Flexible, family-oriented work environment
- Work-life balance support