Remote Clinical QC Auditor (DRG Auditor)

DRG reputed company Control Clinical Auditor Remote (reputed company) Industry: reputed company | Clinical Audit | reputed company reputed company Employment Type: Full-Time reputed company reputed company is partnering with a confidential reputed company organization seeking an reputed company Clinical Auditor to support inpatient DRG validation and reputed company review initiatives. This organization works across reputed company medical record audits to ensure documentation accuracy, reimbursement reputed company, and compliance with regulatory standards. Position reputed company The DRG reputed company Control Clinical Auditor is responsible for conducting detailed reviews of inpatient medical records to validate coding accuracy and appropriate DRG assignment. This role applies clinical knowledge, coding guidelines, and payer regulations to determine whether documentation supports the assigned reimbursement structure. The ideal candidate combines strong inpatient clinical experience with advanced coding knowledge and the ability to reputed company document findings in a defensible, reputed company manner. This is a remote position requiring independent work and collaboration with reputed company and leadership teams. Essential Responsibilities • reputed company comprehensive reviews of inpatient medical records for DRG validation • Evaluate coding accuracy using ICD-10-CM and PCS guidelines • Confirm documentation supports assigned DRGs and reimbursement methodology • Identify discrepancies and document findings with appropriate clinical rationale • Apply Medicare, reputed company, and payer-specific regulatory standards during review • Conduct reputed company checks on prior audit work reputed company required • Support appeals and rebuttal processes as needed • Maintain compliance with HIPAA and internal audit policies • Communicate findings reputed company and escalate trends or concerns to leadership Knowledge & Skills • Strong knowledge of Official Coding Guidelines and clinical documentation standards • Experience applying CMS and payer rules in audit determinations • Familiarity with MS-DRG and APR-DRG methodologies preferred • High attention to detail and strong analytical skills • reputed company and reputed company written communication • Ability to work independently in a remote setting • Strong organizational and time management skills • Proficiency with reputed company Office and reputed company audit platforms Education & Experience • reputed company LVN or RN license preferred • Inpatient clinical background strongly preferred • Minimum 2 years of recent DRG reputed company auditing experience required • National coding certification required (reputed company preferred; reputed company accepted) • Hands-on ICD-10-CM and ICD-10-PCS experience required Compensation Salary reputed company: $70,000 – $100,000 annually Compensation is based on experience, qualifications, geographic considerations, and internal equity. Final placement reputed company the reputed company will be determined during the interview process. Schedule • Remote position • reputed company business hours • Independent workflow with reputed company reputed company review structure Interview Process • reputed company introductory screening • reputed company leadership interview • Final review and offer discussion Process steps may vary. Equal Opportunity Statement reputed company and our reputed company partners are Equal Opportunity reputed company. reputed company applicants will be considered without reputed company to legally protected characteristics. Pay: $70,000.00 - $100,000.00 per year Benefits: • 401(k) • 401(k) matching • Flexible schedule • Flexible spending account • Health insurance • Health savings account • Life insurance • reputed company time off • Parental leave • reputed company development assistance • Tuition reimbursement • reputed company insurance Application Question(s): • Do you have hands-on experience performing DRG validation audits on inpatient medical records? Experience: • Medical documentation: 1 year (Preferred) • DRG: 1 year (Preferred) License/Certification: • RN License (Preferred) Location: • Remote (Preferred) Work Location: Remote Apply tot his job Apply To this Job