DRG Revenue Integrity Auditor

🕒 July 9

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

🦅 H1B Visa Sponsor

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👻 Ghost score 55%

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CorroHealth

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

☁️ SaaS

Healthcare • Healthcare Insurance • SaaS

CorroHealth is a leading provider of clinically led healthcare analytics and technology-driven solutions, focused on enhancing the financial performance of hospitals and health systems. Their integrated solutions and advanced technologies aim to optimize the entire revenue cycle, offering services such as revenue cycle management, clinical documentation, medical coding, and denials management. With a commitment to improving financial health through intelligent technology and expert guidance, CorroHealth addresses complex payer-provider relationships and supports efficient healthcare operations.

📋 Description

• Perform comprehensive Diagnostic Related Group (DRG) validation and quality audits on inpatient medical records • Perform detailed DRG validation reviews of inpatient charts • Ensure ICD-10-CM/PCS codes accurately reflect patients’ clinical conditions and treatment • Validate proper sequencing and accuracy of diagnoses and procedures • Review Present on Admission (POA) indicators, Severity of Illness (SOI), Risk of Mortality (ROM), Case Mix Index (CMI), and Hierarchical Condition Category (HCC) capture • Use current coding references and clinical criteria • Identify documentation gaps and formulate compliant physician queries • Analyze records for coding opportunities, sequencing accuracy, and clinical support • Maintain review quality and meet productivity and quality expectations • Stay current with regulatory, coding, reimbursement, and clinical documentation updates • Support development of training content and educational resources • Mentor and provide shadowing opportunities for new team members • Assist with project analysis, reporting, and client-facing feedback initiatives • Participate in internal and external audits of CDI programs • Protect patient privacy and handle PHI according to company policies and regulatory requirements • Attend required meetings, training sessions, and educational programs • Perform other duties as assigned

🎯 Requirements

• Experience as a coding and revenue integrity professional • Knowledge of Diagnostic Related Group (DRG) validation and inpatient medical record auditing • Proficiency with ICD-10-CM/PCS codes • Knowledge of CMS Guidelines, MCG, InterQual, NCDs, LCDs, and payer clinical policy guidelines • Knowledge of AHIMA and ACDIS coding guidelines and CDI best practices • Ability to identify documentation gaps and formulate compliant physician queries • Ability to analyze records for coding opportunities, sequencing accuracy, and clinical support • Ability to meet productivity and quality expectations • Current knowledge of regulatory, coding, reimbursement, and clinical documentation updates • Ability to protect patient privacy and properly handle PHI • Ability to work at a computer terminal for 6–8 hours per day • Ability to lift and move material weighing up to 20 lbs. infrequently

🏖️ Benefits

• Continued education • Career advancement opportunities • Mentorship from industry experts • Flexible work environment supporting work-life balance