4 drg validation coding auditor jobs found in Houston

Inpatient/DRG Validation Coding Auditor The Inpatient/DRG Validation Coding Auditor performs documentation and coding audits for all acute inpatient services for clients. Identifies coding errors, compliance, and educational opportunities, and optimizes reimbursement by ensuring that the diagnosis/procedure codes and supporting documentation accurately support the services rendered and comply with ethical coding standards/guidelines and regulatory requirements. Performs independent reviews, interprets medical records, and applies in-depth knowledge of coding principles to determine billing/coding/documentation issues and quality concerns. Demonstrates high level of expertise in researching requirements necessary to make compliant recommendations. Has an extensive understanding of reimbursement guidelines, specifically related to DRG (MS, APR, Tricare, etc.) payment systems. Conducts DRG (ex. MS, APR, Tricare) coding and clinical reviews to verify the accuracy of coding, DRG...

DRG Coding Auditor Principal This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical-expense spending. The DRG Coding Auditor Principal is responsible for auditing inpatient medical records on claims paid based on Diagnostic Relation Group (DRG) methodology, including case...

Registered Nurse Clinical Coder DRG Audit Our client is seeking an experienced Registered Nurse Clinical Coder to support DRG audit activities for one of their major healthcare partners. This role focuses on reviewing inpatient medical records, validating DRG assignments, and ensuring coding accuracy from an insurance and payer-side perspective rather than the provider side. This is an excellent opportunity for an RN with coding experience who enjoys analytical work, documentation review, and collaborating with audit teams. Key Responsibilities: Perform DRG audits on inpatient medical records to validate ICD-10 coding accuracy and DRG assignment. Review clinical documentation to ensure compliance with payer guidelines and audit standards. Identify discrepancies, trends, and opportunities for coding improvement. Communicate audit findings clearly and professionally through written reports and outbound calls as needed. Collaborate with internal teams to support audit...

*Registered Nurse Clinical Coder - DRG Audit (100% Remote)* *Position Type:* Contract *Schedule:* Full-time, Remote *Experience Level:* Intermediate (5+ years) *Pay:* $90,000 *Overview* Our client is seeking an experienced *Registered Nurse Clinical Coder* to support DRG audit activities for one of their major healthcare partners. This role focuses on reviewing inpatient medical records, validating DRG assignments, and ensuring coding accuracy from an *insurance and payerside perspective* rather than the provider side. This is an excellent opportunity for an RN with coding experience who enjoys analytical work, documentation review, and collaborating with audit teams. *Key Responsibilities* * Perform *DRG audits* on inpatient medical records to validate ICD10 coding accuracy and DRG assignment. * Review clinical documentation to ensure compliance with payer guidelines and audit standards. * Identify discrepancies, trends, and opportunities for coding improvement. *...