<p>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.</p><p><br></p><p>Key Responsibilities</p><ul><li>Perform detailed audits of inpatient records to validate <strong>ICD-10-CM/PCS coding</strong>, DRG assignment (MS-DRG, APR-DRG, TRICARE), and clinical documentation accuracy.</li><li>Ensure documentation supports coded diagnoses, procedures, severity of illness, and resource utilization.</li><li>Identify overpayments and underpayments through claim analysis (including 30-day lookbacks).</li><li>Provide clear, compliant audit recommendations aligned with Official Coding Guidelines and AHA Coding Clinics.</li><li>Partner with CDI specialists to identify documentation improvement and query opportunities.</li><li>Maintain productivity, quality standards, and client turnaround expectations.</li><li>Stay current on regulatory changes, reimbursement policies, and coding updates.</li><li>Contribute to process improvement initiatives and compliance risk identification.</li></ul><p><br></p>

<ul><li>5+ years inpatient coding experience.</li><li>3+ years facility coding audit experience (DRG/APC validation).</li><li>Strong knowledge of reimbursement methodologies and DRG payment systems.</li><li>Proficiency in EMRs, encoders, proprietary audit systems, and Microsoft Office.</li><li>Deep understanding of HIPAA and confidentiality requirements.</li><li>Strong analytical, written, and verbal communication skills.</li><li>Solid grasp of medical and surgical terminology.</li></ul><p><br></p><p>Education & Certification</p><ul><li>Bachelor’s Degree or equivalent experience.</li><li>Required certification (CCS preferred):</li><li>CPC (Certified Professional Coder)</li><li>CCS (Certified Coding Specialist)</li><li>RHIA (Registered Health Information Administrator)</li><li>RHIT (Registered Health Information Technician)</li></ul><p><br></p>

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