DRG Auditor (Remote)

TL;DR

DRG Auditor (Remote) (ICD-10/DRG): Reviewing post-billed inpatient claims and medical records to identify missed reimbursement opportunities with an accent on diagnosis and procedure coding, clinical documentation, and DRG validation. Focus on matching documentation to ICD-10-CM/PCS codes, detecting undercoded or misclassified cases, and developing accurate reimbursement recommendations for hospital clients.

Location: Remote within the United States; the role may also be office-based depending on company policy.

Company

Healthcare revenue cycle management provider using specialized expertise and an intelligent automation platform to improve reimbursement, reduce denials, and support hospitals, health systems, and ambulatory surgery centers.

What you will do

• Review inpatient claims, billing files, diagnosis and procedure codes, grouping logic, and reimbursement accuracy.
• Analyze medical records and clinical documentation across departments to validate post-bill coding.
• Identify undercoded or misclassified diagnoses and procedures, including high-value DRG opportunities.
• Prepare reimbursement improvement recommendations and submit findings for client approval.
• Collaborate with leadership on case prioritization, workflow management, reporting, and client communication.
• Monitor coding updates, payer guidelines, and DRG methodology changes.

Requirements

• Certified Coding Specialist (CCS) certification is required.
• Associate’s or bachelor’s degree in health information management or a related field.
• 2–3 years of experience in DRG validation, inpatient medical coding, or related coding review.
• Strong knowledge of ICD-10-CM/PCS guidelines, DRG reimbursement methodology, and hospital billing.
• Ability to interpret clinical documentation, navigate EMRs and billing systems, and analyze high volumes of data.
• Strong attention to detail, analytical skills, communication, organization, and ability to handle time-sensitive workloads.

Nice to have

• RHIT or RHIA credential.
• Experience with DRG grouping software, billing databases, and post-bill coding environments.
• Experience working with external clients and strong customer service skills.

Culture & Benefits

• Remote or office-based work arrangement depending on company policy.
• Professional growth and development support.
• Collaborative, flexible, and family-oriented work environment.
• Focus on work-life balance, employee empowerment, and client service.
• Equal opportunity workplace committed to a professional and respectful environment.