• DRG Revenue Integrity Auditor

    Insight Global (Plano, TX)


    Job Description

    Insight Global is seeking experienced DRG Auditors to join a remote healthcare organization. The DRG Revenue Integrity Auditor will perform Diagnostic Related Group (DRG) validation and quality audits on inpatient charts to ensure accurate coding and compliance with federal regulations. This is a remote opportunity and the salary for this role is 95-115k based on the candidates years of experience.

    Key Responsibilities:

    Conduct thorough chart reviews to validate that assigned codes accurately reflect the patient’s clinical picture.

     

    Utilize ICD-10-CM and ICD-10-PCS coding systems to ensure proper code sequencing and accuracy.

     

    Validate Present on Admission (POA) indicators, Severity of Illness (SOI), Risk of Mortality (ROM), Hierarchical Condition Category (HCC) capture, Case Mix Index (CMI), and other coding factors.

     

    Apply current clinical criteria including MCG, InterQual, payer clinical policy bulletins, CMS guidelines, NCDs, and LCDs.

     

    Adhere to coding guidelines and Clinical Documentation Improvement (CDI) best practices as endorsed by ACDIS and AHIMA.

     

    Compose and send queries when documentation is insufficient or unclear.

     

    Identify query opportunities and ensure accurate code assignment and sequencing.

     

    Maintain high-quality standards in chart reviews to accurately reflect the patient’s condition.

     

    Stay current with medical coding guidelines and industry developments.

     

    Assist in developing training materials and provide onboarding support to new hires.

     

    Support project data analysis, reporting, and feedback for internal teams and external clients.

     

    Maintain professional conduct and ensure the confidentiality of Protected Health Information (PHI).

     

    Meet or exceed established production and quality metrics.

     

    Attend all required meetings and training sessions.

     

    May be asked to audit clients’ CDI programs, including query reviews and coding analysis.

     

    Responsible for maintaining access credentials for company systems and EMRs.

     

    Perform other duties as assigned by management.

     

    We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to [email protected] learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.

     

    Skills and Requirements

     

    -Five or more years working in an acute care setting or a third-party vendor as a DRG Auditor or Clinical Documentation Specialist (CDS).

     

    -CCS Certification RN or BSN

     

    RHIT or RHIA