Medical Coding Auditor - DRG

We are seeking a detail-oriented Medical Coding Auditor – DRG to join a high-volume medical review team. This role focuses on validating DRG assignments, medical coding accuracy, and claims integrity to support cost control and compliance.

✅ Key Responsibilities

• Perform DRG validation reviews on inpatient medical records
• Audit coding accuracy and identify discrepancies in claims
• Coordinate with claims teams to implement rate adjustments
• Analyze trends and prepare monthly & quarterly audit reports
• Ensure compliance with HIPAA and documentation standards
• Act as a subject matter expert for coding and audit-related issues

✅ Required Qualifications

• Certification required: CPC, RHIT, RHIA, CPMA, or CIC
• Minimum 3+ years of experience in medical coding & auditing
• Strong knowledge of ICD-10, DRG, and inpatient coding
• Experience in medical record review and validation
• Understanding of payer guidelines and claims auditing

✅ Preferred Qualifications

• Experience with DRG validation and inpatient audits
• Prior payer-side experience ( BCBS, Optum, etc. )
• Strong analytical, reporting, and documentation skills