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The Inpatient/DRG Validation Coding Auditor is responsible for reviewing acute inpatient medical records to ensure accurate coding, compliant documentation, and appropriate DRG assignment. The role focuses on identifying coding errors, ensuring regulatory compliance, optimizing reimbursement, and providing education and feedback to coders and CDI teams.
Job Responsibility:
Perform detailed audits of inpatient records to validate ICD-10-CM/PCS coding, DRG assignment (MS-DRG, APR-DRG, TRICARE), and clinical documentation accuracy
Ensure documentation supports coded diagnoses, procedures, severity of illness, and resource utilization
Identify overpayments and underpayments through claim analysis (including 30-day lookbacks)
Provide clear, compliant audit recommendations aligned with Official Coding Guidelines and AHA Coding Clinics
Partner with CDI specialists to identify documentation improvement and query opportunities
Maintain productivity, quality standards, and client turnaround expectations
Stay current on regulatory changes, reimbursement policies, and coding updates
Contribute to process improvement initiatives and compliance risk identification
Requirements:
5+ years inpatient coding experience
3+ years facility coding audit experience (DRG/APC validation)
Strong knowledge of reimbursement methodologies and DRG payment systems
Proficiency in EMRs, encoders, proprietary audit systems, and Microsoft Office
Deep understanding of HIPAA and confidentiality requirements
Strong analytical, written, and verbal communication skills
Solid grasp of medical and surgical terminology
Bachelor’s Degree or equivalent experience
Required certification (CCS preferred): CPC (Certified Professional Coder)
CCS (Certified Coding Specialist)
RHIA (Registered Health Information Administrator)