Job Description

Insight Global is hiring DRG Validation Auditors for one of our clients to sit 100% remote. Candidates should have an extensive background in either facility-based nursing, clinical documentation, and/or inpatient coding and has a high level of understanding of reimbursement guidelines specifically an understanding of the MS-DRG, AP-DRG, and APR-DRG payment systems. This position is responsible for auditing inpatient medical records and generating high-quality recoverable claims for the benefit of our client and their clients. They are responsible for performing clinical reviews of medical records and other documentation to evaluate issues of coding and DRG assignment accuracy.

DESIRED SKILLS

• 5-7+ years of working with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG with a broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, medical necessity criteria, and coding terminology.

• Expert coding knowledge (DRG & ICD-10)

• Proficiency in Word, Access, Excel, and other applications.

• Education (at least one of the following is required):

  • Associates or bachelor’s degree in Nursing (active/unrestricted license
  • Associate or bachelor’s degree in Health Information Management (RHIA or RHIT)
  • Equivalent experience of 5+ years’ experience in claims auditing, quality assurance, or recovery auditing...ideally in a DRG / Clinical Validation Audit setting or a hospital environment.

• Coding Certification (at least one of the following are required and are to be maintained as a condition of employment)

  • RHIA or RHIT
  • Inpatient Coding Credential - CCS or CIC preferred
  • Candidates who hold a CCDS or CPC will be given consideration but will need to obtain an inpatient coding certification within 1 year of their hire date with the company.