We are looking for an experienced DRG Validation Coding Auditor to support accurate, compliant inpatient coding reviews for acute care services in Roanoke, Virginia. This position focuses on evaluating medical documentation, validating diagnosis and procedure code assignment, and identifying opportunities to strengthen coding accuracy, regulatory compliance, and reimbursement integrity. The ideal candidate brings strong inpatient auditing expertise, sound clinical judgment, and the ability to communicate well-supported recommendations to coding and documentation teams. Responsibilities: • Review acute inpatient records to assess whether documented conditions, procedures, and assigned DRGs are accurately supported by the medical record. • Analyze coding outcomes for compliance with official inpatient coding guidance, payer-specific reimbursement methodologies, and applicable regulatory standards. • Investigate discrepancies that may affect payment accuracy, including potential underpayments, overpayments, and unsupported code assignment within retrospective claim reviews. • Prepare clear audit findings that explain recommended revisions, citing relevant coding authorities and clinical rationale for each conclusion. • Partner with coding professionals and clinical documentation improvement staff to address documentation gaps and identify appropriate query opportunities. • Use auditing platforms, encoders, and internal workflow tools to complete reviews efficiently while meeting turnaround expectations and quality benchmarks. • Monitor developments in inpatient coding regulations, reimbursement updates, and industry guidance to maintain current audit practices. • Contribute ideas that improve audit processes, strengthen compliance oversight, and uncover additional areas of financial or coding risk.

• At least 5 years of coding experience, including substantial inpatient coding exposure. • Minimum of 3 years of hospital or facility coding audit experience, preferably in DRG validation or related inpatient audit work. • Strong knowledge of ICD-10 coding guidelines, DRG assignment methodology, reimbursement principles, and medical necessity documentation review. • Ability to interpret complex inpatient records and apply coding, clinical, and compliance standards with accuracy and consistency. • Proficiency with coding software, encoder applications, and Microsoft Office tools. • Effective written and verbal communication skills with the ability to deliver concise, well-supported audit feedback. • Bachelor’s degree or equivalent combination of education and relevant experience. • Commitment to maintaining required certifications, ongoing education, confidentiality standards, and productivity expectations.

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Roanoke, VA
remote
Permanent / Full Time
86000 - 90000 USD / Yearly
We are looking for an experienced DRG Validation Coding Auditor to support accurate, compliant inpatient coding reviews for acute care services in Roanoke, Virginia. This position focuses on evaluating medical documentation, validating diagnosis and procedure code assignment, and identifying opportunities to strengthen coding accuracy, regulatory compliance, and reimbursement integrity. The ideal candidate brings strong inpatient auditing expertise, sound clinical judgment, and the ability to communicate well-supported recommendations to coding and documentation teams. Responsibilities: • Review acute inpatient records to assess whether documented conditions, procedures, and assigned DRGs are accurately supported by the medical record. • Analyze coding outcomes for compliance with official inpatient coding guidance, payer-specific reimbursement methodologies, and applicable regulatory standards. • Investigate discrepancies that may affect payment accuracy, including potential underpayments, overpayments, and unsupported code assignment within retrospective claim reviews. • Prepare clear audit findings that explain recommended revisions, citing relevant coding authorities and clinical rationale for each conclusion. • Partner with coding professionals and clinical documentation improvement staff to address documentation gaps and identify appropriate query opportunities. • Use auditing platforms, encoders, and internal workflow tools to complete reviews efficiently while meeting turnaround expectations and quality benchmarks. • Monitor developments in inpatient coding regulations, reimbursement updates, and industry guidance to maintain current audit practices. • Contribute ideas that improve audit processes, strengthen compliance oversight, and uncover additional areas of financial or coding risk.
2026-07-22T00:00:00Z

DRG Validation Coding Auditor Job in Roanoke, VA | Robert Half