Auditor

The Judge Group is hiring DRG Revenue Integrity Auditors!Position Summary:The DRG Revenue Integrity Auditor (DRG - A) performs Diagnostic Related Group (DRG) validation and quality audits on inpatient charts to ensure coding accuracy and compliance with federal regulations. This role supports clinical documentation integrity (CDI) by analyzing records for accurate coding and sequencing. The auditor will apply ICD-10-CM/PCS coding standards, review severity of illness (SOI) and risk of mortality (ROM), and ensure Hierarchical Condition Category (HCC) capture while maintaining compliance with CMS and payer guidelines.Key Responsibilities:Conduct DRG validation and quality audits of inpatient charts to ensure accurate coding.Validate proper sequencing of ICD-10-CM/PCS codes, POA assignments, SOI, ROM, and HCC capture.Utilize current clinical criteria, MCG, InterQual, NCDs, LCDs, and payer policy bulletins to ensure compliance.Adhere to coding guidelines and CDI best practices set by ACDIS and AHIMA.Review medical records for coding accuracy and query opportunities.Maintain quality standards and productivity metrics for chart reviews.Provide training and mentorship to new hires while assisting in the development of training materials.Conduct project data analysis, reporting, and feedback for both internal stakeholders and clients.Ensure strict privacy and confidentiality of PHI, adhering to AHIMA’s Standards of Ethical Coding.Participate in client audits to assess CDI program accuracy and effectiveness.Maintain professional credentials, staying updated on coding guidelines, clinical advancements, and compliance regulations.Attend mandatory meetings and training sessions.Qualifications & Requirements:CCS coding credential from AHIMA is required.5+ years of experience in an acute care setting or third-party vendor role as a DRG Auditor or Clinical Documentation Specialist (CDS).Prior experience as a CDI/Coding Auditor is preferred but not required.Skills & Competencies:Expertise in telecommuting and electronic medical record systems.Strong analytical and math skills for accurate data interpretation.Proficiency in Microsoft Word, Excel, Outlook, Teams, and other workplace applications.Ability to work independently and switch between multiple clients/projects.Strong team collaboration skills and attention to detail.Ability to handle and maintain multiple files efficiently.Join our team as a DRG Revenue Integrity Auditor and play a vital role in ensuring coding accuracy, compliance, and optimal reimbursement—apply today to make a meaningful impact in healthcare!

Created: 2025-06-04