DRG Revenue Integrity Auditor

About Us

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.

Job Summary

The DRG Revenue Integrity Auditor performs Diagnostic Related Group (DRG) validation and quality audits on Inpatient charts. This role involves chart reviews to ensure that all reviewed charts capture the patient’s true clinical picture from the codes assigned by the facility’s coders in compliance with federal laws. The auditor will utilize International Classification of Diseases - Clinical Modification (CM) and Procedure Coding System (PCS) Terminology to ensure accurate coding. Responsibilities include validating proper sequencing and accuracy of ICD-10-CM/PCS codes, POA assignments, severity of illness (SOI), risk of mortality (ROM), Hierarchical Condition Category (HCC) capture CMI, and other coding factors. This role requires the usage of current Clinical Criteria, MCG, InterQual, payers’ Clinical Policy Bulletins, CMS Guidelines, NCDs, and/or LCDs. Adherence to all coding guidelines and CDI best practices, as endorsed by ACDIS and AHIMA, is essential to determine correct coding that is clinically supported. The role involves composing and sending queries when necessary, analyzing records for potential query opportunities and appropriate code assignment along with correct code sequencing. Maintaining review quality by ensuring the true clinical picture is captured timely is key. Staying up to date with medical and coding guidelines, along with advancements within their field, is also crucial. The DRG Revenue Integrity Auditor will support CorroHealth in developing accurate training materials, provide training and shadowing to new hires, and assist with project data analysis, reporting, and feedback internally and externally. Professional etiquette must be maintained, and all PHI must be appropriately stored and delivered. The role requires meeting or exceeding production and quality metrics and attending all mandatory meetings and trainings. Additionally, the DRG Revenue Integrity Auditor may be required to audit clients’ clinical documentation integrity (CDI) programs, including query review, analysis of coding, and overall program accuracy. Maintaining company and EMR access logins and passwords is also a responsibility. Other position-related duties as delegated by management will be performed. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Remote Position

This is a remote position.

Essential Duties And Responsibilities

Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.

Important Duties And Responsibilities

• Adherence to all coding guidelines and CDI best practices, as endorsed by ACDIS and AHIMA, to determine correct coding that is clinically supported.
• Analyze records for potential query opportunities and appropriate code assignment and code sequencing.
• Maintain quality of reviews and ensuring the true clinical picture is captured, along with ensuring chart review productivity.
• Stay up to date with official coding guidelines, coding clinics and clinical criteria.
• Available to provide training to other new hires, if required, along with supporting development of training materials, as well as clinical, coding and CDI policies.
• Assist with project data analysis, reporting, and feedback both internally and to clients.
• In all situations, protecting the privacy and confidentiality of patient health and client information, and follows the Standards of Ethical Coding as set forth by AHIMA and adheres to official coding guidelines and compliance practices, standards, and procedures.
• Conduct chart reviews as assigned, meeting the productivity standards as set forth for each project or record type.
• Communicate with coworkers in an open and respectful manner that promotes teamwork and knowledge sharing.
• When interacting with clients, always conduct themselves in a professional manner, exhibiting excellent relationship, work performance, and communication skills so as to support the company and its business interests.
• Maintain professional credentials and knowledge of CDI, coding, reimbursement, and compliance issues through continuing education.
• Other duties and responsibilities, as assigned.

Work Experience

• CCS Required.
• Five or more years working in an acute care setting or a third-party vendor as a DRG Auditor or Clinical Documentation Specialist (CDS).
• Prior experience of working as a CDI/Coding auditor is preferred but NOT a requirement.

Knowledge, Skills & Abilities

• Experience with telecommuting and electronic medical record systems required.
• Good computer skills and familiarity with commonly used work apps, such as MS Word, MS Excel, MS Outlook, Teams, etc.
• Strong analytical skills.
• Works well with numbers, using basic math skills.
• Strong team player.
• Ability to work with multiple and diverse clients and projects.
• Ability to switch between multiple clients throughout the day and week.
• Ability to work with minimal supervision.
• Ability to maintain and access multiple files.

We Offer

• Quality of life with a remote predictable, full-time schedule.
• Exempt/Salaried positions.
• Opportunities for career growth within the organization.
• Medical, Dental, Vision coverage, 401K with match.
• Long-term disability insurance, life insurance and more.
• Holidays Time and ample paid time off.
• Allowance for CME and/or license renewal.

Physical Demands

Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.

Key skills/competency

• DRG Revenue Integrity Auditor
• Diagnostic Related Group (DRG)
• Inpatient Chart Audits
• ICD-10-CM/PCS
• Clinical Documentation Integrity (CDI)
• Query Writing
• Coding Guidelines
• Revenue Cycle Management
• Medical Auditing
• Healthcare Reimbursement