Description
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.


Key Responsibilities

+ 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 a...