[Hiring] PRN DRG Revenue Integrity Auditor @CorroHealth

Role Description

The DRG Revenue Integrity Auditor (DRG‑A) performs Diagnostic Related Group (DRG) validation and quality audits on inpatient medical records. This role ensures coded data accurately reflects the patient’s clinical picture and complies with federal regulations. The Auditor reviews:

• ICD‑10‑CM/PCS code assignment
• POA indicators
• SOI/ROM
• HCC capture
• Case mix index (CMI)
• Related coding elements to support correct reimbursement

The Auditor applies current clinical criteria (e.g., MCG, InterQual), payer clinical policy bulletins, CMS guidelines, NCDs/LCDs, and official coding guidelines. The role may also participate in CDI program audits, assess query opportunities, and support both internal and client‑facing reporting. The Auditor maintains high standards of accuracy, productivity, and professional conduct while protecting patient and client confidentiality.

Qualifications

• Five or more years of experience in an acute care setting or third‑party vendor as a DRG Auditor or Clinical Documentation Specialist (CDS).
• Prior experience as a CDI or coding auditor (not required).
• Experience working remotely and with electronic medical record (EMR) systems.
• Proficiency with MS Word, Excel, Outlook, Teams, and other standard software.
• Strong analytical skills and comfort working with numerical data.
• Ability to manage multiple diverse clients and switch between projects as needed.
• Strong teamwork orientation and ability to work effectively with minimal supervision.
• Ability to maintain and organize multiple files and work in a fast‑paced environment.

Requirements

• Perform DRG validation and quality audits on inpatient charts.
• Validate sequencing and accuracy of ICD‑10‑CM/PCS codes, POA status, SOI/ROM, HCC capture, and other coding factors.
• Ensure coded data aligns with federal regulations and organizational standards.
• Analyze charts for potential query opportunities and confirm correct coding and sequencing.
• Perform audits of client Clinical Documentation Integrity (CDI) programs when assigned.
• Maintain timely and accurate reviews to ensure the true clinical picture is captured.
• Follow all official coding guidelines, AHIMA Standards of Ethical Coding, and CDI best practices endorsed by ACDIS/AHIMA.
• Apply current clinical criteria (e.g., MCG, InterQual), payer bulletins, and CMS regulatory guidance.
• Stay up to date on changes in clinical guidance, coding clinics, and coding regulations.
• Provide training, shadowing, and support for new hires when requested.
• Assist in developing training materials and updates to clinical, coding, and CDI policies.
• Support internal and external project data analysis, reporting, and feedback.
• Maintain strict confidentiality of PHI and client information at all times.
• Communicate with coworkers professionally, promoting teamwork and knowledge sharing.
• Demonstrate strong relationship-building and communication skills in client interactions.
• Meet or exceed assigned productivity and accuracy metrics for each project or record type.
• Ensure production standards are consistently achieved while maintaining high-quality reviews.
• Participate in mandatory meetings, trainings, and continuing education activities.
• Maintain company and EMR access credentials and comply with security requirements.
• Perform additional duties as assigned by management.

Physical Demands

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. The following physical demands are required:

• Regular eye-hand coordination and manual dexterity to operate office equipment.
• Ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions.
• Ability to sit for prolonged periods.
• Occasionally lift and move material weighing up to 20 lbs.
• Ability to manage elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.