Remote Inpatient DRG Coding Quality RN Auditor

$71,760 - $86,320/Yr

The CSI Companies - Minnetonka, MN

Full-time - Mid Level

Remote - Minnetonka, MN

51-100 employees

Administrative and Support Services

About the position

The Remote Inpatient DRG Coding Quality RN Auditor is responsible for auditing inpatient claims using expertise in MS-DRG and APR-DRG coding methodologies. This role involves validating ICD-10 diagnosis and procedure codes, ensuring accurate DRG assignments, and identifying overpayments. The position is remote, allowing for flexibility in work location, and is part of a temp-to-hire opportunity with a Fortune 100 healthcare client.

Responsibilities

• Conduct MS-DRG and APR-DRG coding reviews to validate the accuracy of DRG assignments and reimbursement, focusing on overpayment identification.
• Utilize expert knowledge of ICD-10-CM/PCS codes, code sequencing, POA assignment, and discharge dispositions per CMS, ICD-10, and AHA guidelines.
• Apply clinical expertise to ensure medical coding accuracy and substantiate code assignments based on documentation and coding standards.
• Write clear, concise rationales supporting audit findings, grounded in ICD-10-CM/PCS guidelines and AHA Coding Clinic references.
• Use proprietary workflow and encoder tools to efficiently manage claim reviews and audit determinations.
• Keep current with coding guidelines, reimbursement trends, and client-specific requirements to maintain compliance.
• Manage daily case assignments with an emphasis on quality and high productivity in a matrix-driven environment.
• Provide clinical expertise and support to other investigative and analytical teams within the organization.

Requirements

• Unrestricted Registered Nurse license
• Associates degree or higher
• CCS or CIC certification (or must obtain within six months of hire)
• 3+ years of experience with MS-DRG/APR-DRG coding in a hospital setting, including strong ICD-10 Official Coding Guidelines and DRG reimbursement methodology knowledge
• Advanced understanding of ICD-10-CM and ICD-10-PCS coding principles, including principal diagnosis selection, complications/comorbidities (CCs/MCCs), SOI, and ROM considerations
• A reliable high-speed internet connection
• Ability to pass a background check and drug test
• Private, quiet, and distraction-free workspace in a room with a closed-door

Nice-to-haves

• Large corporation experience
• Prior experience in DRG overpayment audits (concurrent or retrospective)
• Experience in readmission reviews and DRG encoder tools (e.g., 3M)
• Proficiency in Microsoft Excel for data entry, sorting/filtering, and spreadsheet management
• Experience in health plans, managed care, or insurance, with a strong understanding of healthcare claims, industry terminology, and regulations

Benefits

• Weekly pay
• Medical, dental, and vision coverage
• Voluntary Life and AD&D coverage
• Paid Training
• Opportunity for advancement upon performance and availability
• 3 weeks of PTO
• Extremely low full coverage medical coverage