DRG Auditor

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EnableComp

WebsiteLinkedInAll Job Openings

501 - 1000 employees

💼 Consulting

🛡️ Insurance

📦 Logistics

💰 Venture Round on 2022-07

Consulting • Insurance • Logistics

EnableComp is a company that specializes in revenue cycle management (RCM) for healthcare providers and health systems across the United States. They focus on processing complex claims related to Veterans Administration, Workers' Compensation, Motor Vehicle Accidents, and Out-of-State Medicaid, as well as denial management for all payer classes. By leveraging intelligent automation and their proprietary E360 RCM™ platform, EnableComp helps healthcare providers increase revenue, control costs, and streamline billing processes. With expertise in handling complex claims, the company ensures accurate and timely reimbursement, providing significant uplift to collections and improving the financial performance of its clients.

📋 Description

• 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

• 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

• 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