DRG Coder, Registered Nurse
Remote | Full-Time | Healthcare | Clinical Documentation & Coding
About the Role
We are seeking an experienced DRG Coder / Clinical Auditor (RN) to conduct comprehensive DRG quality and validation audits of inpatient medical records. This role is critical in ensuring accurate DRG assignment, strong clinical documentation support, and compliance with Medicare and CMS regulations. The ideal candidate is highly analytical, clinically strong, and comfortable working independently in a production-driven audit environment.
You will play a key role in improving coding accuracy, reimbursement integrity, and regulatory compliance while providing clear, defensible audit findings.
Key Responsibilities
DRG Validation & Chart Review
Perform in-depth DRG quality audits of inpatient medical records.
Validate DRG assignments against clinical documentation and coding guidelines.
Identify missed opportunities, discrepancies, and documentation gaps impacting reimbursement.
Clinical Documentation Review
Evaluate physician documentation to ensure clinical indicators appropriately support assigned diagnoses and procedures.
Apply strong clinical judgment to assess severity of illness, risk of mortality, and DRG impact.
Audit & Compliance
Ensure compliance with Medicare, CMS, and payer-specific documentation and coding requirements.
Identify trends, risks, and improvement opportunities related to DRG accuracy and quality.
Support organizational initiatives focused on audit accuracy, compliance, and revenue integrity.
Coding Expertise
Apply extensive hands-on knowledge of ICD-10-CM and ICD-10-PCS , Coding Clinic guidance, and Official Coding Guidelines.
Utilize MS-DRG and APR-DRG methodologies when reviewing and validating records.
Communication & Reporting
Document audit findings clearly, concisely, and professionally.
Communicate results and rationale effectively to internal stakeholders as required.
Additional Duties
Support other documentation, coding, and audit-related activities as assigned.
Required Qualifications
Licensure
Active Registered Nurse (RN) license required (Non-RN candidates will not be considered)
Experience
Minimum of 2 years of recent DRG quality auditing experience in a hospital or health plan setting .
Extensive hands-on inpatient ICD-10-CM and ICD-10-PCS coding experience required.
Certifications
National coding certification required (AHIMA or AAPC).
CCS, CIC, or equivalent strongly preferred .
Technical Knowledge
Proficiency in Medicare and CMS documentation and coding guidelines .
Strong understanding of MS-DRG and APR-DRG methodologies .
Advanced familiarity with Coding Clinic citations and Official Coding Guidelines .
Soft Skills
Exceptional attention to detail and analytical accuracy.
Strong critical thinking and problem-solving skills.
Clear, professional written and verbal communication.
Ability to work independently in a fast-paced, production-driven environment.
Tools
Proficient in Microsoft Office Suite (Excel, Word, Outlook).
Compensation
Pay Range: $90,000 - $104,841
Compensation is based on location, experience, qualifications, and internal equity. Final compensation may vary following the interview and assessment process.
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