PRN DRG Revenue Integrity Auditor

Accountabilities:

• • Perform DRG validation and quality audits of inpatient medical records to assess coding accuracy, completeness, and clinical validity.
  • Review ICD-10-CM/PCS code assignment and sequencing, POA indicators, SOI/ROM, HCC capture, case-related coding factors, and other elements affecting reimbursement.
  • Confirm that coded data accurately reflects the patient’s documented clinical condition and complies with applicable federal regulations and organizational standards.
  • Analyze medical records to identify potential clinical documentation and physician query opportunities and validate appropriate coding and sequencing.
  • Conduct audits of Clinical Documentation Integrity (CDI) programs when assigned.
  • Apply current official coding guidelines, CDI best practices, CMS guidance, NCDs/LCDs, payer clinical policies, and recognized clinical criteria such as MCG and InterQual.
  • Stay current with changes to coding regulations, clinical guidance, coding clinics, and industry standards.
  • Support internal and client-facing reporting, project analysis, feedback, and quality improvement initiatives.
  • Provide training, shadowing, and subject-matter support to new team members when requested, and contribute to training materials and policy updates.
  • Maintain strict confidentiality of protected health information (PHI) and client information while complying with privacy, security, and access requirements.
  • Build professional relationships with colleagues and clients and communicate findings clearly and effectively.
  • Meet or exceed assigned productivity, accuracy, and quality expectations across projects and record types.
  • Manage multiple clients and projects, adapt to changing priorities, and maintain organized records in a fast-paced environment.
  • Participate in required meetings, training, continuing education, and other activities assigned by management.

  Requirements:

  • 5+ years of experience working in an acute care setting or with a third-party healthcare vendor as a DRG Auditor or Clinical Documentation Specialist (CDS).
  • Prior experience as a CDI or coding auditor is preferred but not required.
  • Strong knowledge of inpatient DRG validation, ICD-10-CM/PCS coding, clinical documentation, reimbursement principles, and applicable regulatory requirements.
  • Familiarity with POA indicators, SOI/ROM, HCC capture, sequencing, and identifying clinically supported query opportunities.
  • Working experience with electronic medical record (EMR) systems and the ability to operate effectively in a remote environment.
  • Strong analytical skills, including comfort reviewing complex clinical information and working with numerical and reimbursement-related data.
  • Ability to interpret and apply official coding guidance, clinical criteria, payer policies, and CMS requirements.
  • Proficiency with Microsoft Word, Excel, Outlook, Teams, and other standard business software.
  • Strong attention to detail and commitment to maintaining consistently high-quality audit results.
  • Ability to manage multiple diverse clients, switch efficiently between projects, and meet competing deadlines.
  • Excellent communication and relationship-building skills, with the ability to collaborate effectively with internal teams and external clients.
  • Ability to work independently with minimal supervision while maintaining accountability for productivity, accuracy, and deadlines.
  • Strong commitment to professional ethics, confidentiality, data security, and patient privacy.
  • Ability to work at a computer for extended periods and manage an environment with multiple priorities and interruptions.

  Benefits:

  • Part-time, fully remote opportunity within the United States.
  • Opportunity to apply advanced DRG auditing and clinical documentation expertise across diverse healthcare projects.
  • Exposure to a broad range of inpatient coding, CDI, reimbursement, and revenue integrity initiatives.
  • Opportunities to support training, knowledge sharing, and continuing professional education.
  • Collaborative environment with opportunities to work directly with internal teams and client stakeholders.
  • Flexible remote work setting designed for experienced professionals who can operate independently.
  • Opportunity to contribute to initiatives that improve coding accuracy, clinical documentation quality, regulatory compliance, and reimbursement integrity.