Position Description:

The DRG Validation Auditor is a member of the CGI Healthcare Compliance, DRG Validation Team, with responsibility for reviewing medical records to determine the accuracy of coding and reimbursement for clinical services rendered to beneficiaries of health plans, including Commercial and Government Clients.

The DRG Validation Auditor is charged with rendering appropriate, well-supported, and thoroughly-documented decisions which may result in the identification of improper payments (overpayments and underpayments) on paid claims on behalf of the client from various providers of clinical services, including but not limited to acute care, long-term acute care, acute rehabilitation, and skilled nursing facilities, as well as other provider types and care settings.

The DRG Validation Auditor is prepared for the role through a detailed, well-defined training process, gaining knowledge and skills in methods for review of the medi...