CDI-DRG Validation Auditor at AAPC

Salt Lake City, Utah, United States -

Full Time

Start Date

Immediate

Expiry Date

08 Jan, 26

Salary

0.0

Posted On

10 Oct, 25

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

CDI Expertise, DRG Validation, Inpatient Coding, Outpatient Coding, Pediatric Healthcare, ICD-10-CM, ICD-10-PCS, CPT Coding, HCPCS Coding, Coding Auditing, Documentation Improvement, Coding Guidelines, Cost Reduction Strategies, Electronic Health Records, Anatomy, Physiology

Industry

Description

This is a remote contract position. We are seeking an experienced DRG Validation Auditor with strong CDI expertise to perform documentation and coding reviews that will support the development of our AI-driven auditing platform. The Auditor will collaborate with clinicians, engineers, product managers, and domain experts to validate data quality and ensure accurate coding practices. This role offers the opportunity to influence the next generation of auditing software while working in a dynamic environment with a high-performing, cross-functional team. The ideal candidate for this position needs to have both an inpatient and outpatient coding / auditing background focused on the following disciplines from a coding and billing perspective: Inpatient MS-DRG/APR-DRG, and Outpatient CPT-4/HCPCS coding and auditing, with a strong focus on pediatric healthcare services and coding accuracy and payer claim processing. Job Duties: Review hospital records for clinical supports to validate the accuracy of ICD-10-CM, ICD-10-PCS, and DRG and APR group appropriateness, CPT and HCPCS inpatient patient and outpatient facility claims. Identify codes that may have been over or under assigned, ensuring accurate reimbursement aligned with regulatory and contractual guidelines. Identify and resolve complex coding discrepancies. Write technical rationales for correct clinical, documentation and code changes. Communicate complex coding findings to project lead and other cross functional teams. Be responsible and accountable for maintaining confidentiality, integrity, and availability of protected health information. Follow HIPAA security policies and procedures affecting your job, and report any suspected or actual violation or breach. Minimum Requirements: Extensive knowledge of healthcare industry and experience in and around coding, billing, auditing, compliance and reimbursement for Inpatient and Outpatient facility. Must have extensive pediatric inpatient facility experience. Strong knowledge of clinical indicators, diagnostic criteria, and evidence-based guidelines to support accurate code assignment. 5 years of CDI expertise in facility inpatient and outpatient services with DRG and APR-DRG as well as familiarity with clinical documentation improvement practices. Extensive knowledge of current Official Coding Guidelines and Coding Clinic citations. Strong background in cost reduction strategies by ensuring correct claims payment and appropriate diagnosis-related group (DRG) assignment including familiarity with inpatient denial coding systems (e.g. CARC codes). Proficiency in coding software, electronic health record systems and familiar with how AI tools can assist in identifying over/under-assigned DRGs. Experience in working with technical teams building coding and large language models. High level proficiency in anatomy, physiology, disease process, and pharmacology. Detail oriented and deadline driven attitude. Ability to think critically and determine the best method for resolving challenges. Strong organizational skills, a strong sense of accountability, a proactive work ethic. Certification Requirements: CDIP (AHIMA) or CCDS (ACDIS) RHIA, RHIT, or CCS from AHIMA and/or CPMA, CIC, COC from AAPC Preferred Attributes: Humble - Learns, adapts, and improves relentlessly. Seeks feedback without insecurity and implements coaching. Recognizes others' contributions gratefully. Approaches work and relationships with an abundance mentality. Places the needs of others above self. Supportive - Empowers and uplifts others. Listen actively and responds with empathy and understanding. Prioritizes well-being and growth of team members and customers ahead of own interest. Faces challenges together, believing in collective strength and unity. Driven - Self-starts and stays highly motivated to achieve ambitious goals. Shares contagious energy and enthusiasm liberally. Takes initiative without always being directed. Demonstrates confidence in decision-making and effectively balances autonomy and authority with accountability. Transparent - Aligned with a culture of openness, integrity, and trustworthiness. Follows through on commitments to internal and external parties. Maintains strict accountability and values the trust placed in them by others. Innovative - Entrepreneurial spirit with a scrappy mentality. Dreams big, sees opportunity, pursues full potential, and finds ways to accomplish the impossible. Rolls up sleeves and does real work. Works quickly, intelligently, and flexibly. What we Offer Compensation commensurate with experience Comprehensive benefits package including medical, dental and vision insurance Health Savings Account Generous PTO and Holiday Pay 401(k) retirement plan Remote/virtual-office consideration AAPC is an Equal Opportunity Employer. This company does not and will not discriminate in employment and personnel practices on the basis of race, sex, age, disability, religion, national origin or any other basis prohibited by applicable law. Hiring, transferring and promotion practices are performed without regard to the above listed items. We are an Equal Opportunity Employer. We are an Equal Opportunity Employer. This company does not and will not discriminate in employment and personnel practices on the basis of race, sex, age, disability, religion, national origin, or any other basis prohibited by applicable law. Hiring, transferring and promotion practices are performed without regard to the above-listed items.

Responsibilities

The Auditor will perform documentation and coding reviews to support the development of an AI-driven auditing platform. They will collaborate with various teams to validate data quality and ensure accurate coding practices.