ECU Health · 6 hours ago
DRG Validation Auditor
United States
Full-time
Remote
Senior Level
5+ years expECU Health is a mission-driven, 1,708-bed academic health care system serving over 1.4 million people. The DRG Validation Auditor is responsible for ensuring the integrity of inpatient medical records by auditing them to confirm accurate clinical documentation and coding, while also making recommendations for compliance and education based on audit results.
Hospital & Health Care
Responsibilities
Analyze and audit claims by integrating medical chart coding principles and guidelines
Proficiency in DRG assignments, ICD-10 CM, ICD-10-PCS, official coding guidelines, medical terminology, human anatomy and physiology, pathophysiology, pharmacology, and proficiency in Microsoft Office products (Word and Excel)
Generate audit determinations and compile detailed audit findings letters
Excellent verbal and written communication skills
Writes clear, accurate and concise recommendations in support of findings while providing feedback and education to the coders, referencing current ICD-10-CM/PCS Official Coding Guidelines and AHA Coding Clinics
Ability to work independently and exercise independent judgment
Critical thinking skills
Research coding questions asked by coding and other areas in a timely manner
Must have knowledge of the Clinical Documentation Management Program and assist the Documentation Specialist with questions regarding code/DRG assignment
Serves as back up for the Coding Specialist II, Coding Specialist III and Coding Auditor when needed
Make recommendations on coding education and training based on audit results
Other duties and responsibilities, as assigned
Maintains AHIMA credentials, CEUs and up to date knowledge of coding guidelines
Qualification
Required
Detailed understanding of medical coding principles, coding guidelines, coding clinics
Ability to perform objective medical audits
Advanced ICD-10 coding expertise and guidelines
Proficiency in DRG assignments, ICD-10 CM, ICD-10-PCS, official coding guidelines, medical terminology, human anatomy and physiology, pathophysiology, pharmacology
Proficiency in Microsoft Office products (Word and Excel)
Excellent verbal and written communication skills
Ability to write clear, accurate and concise recommendations in support of findings
Ability to provide feedback and education to the coders, referencing current ICD-10-CM/PCS Official Coding Guidelines and AHA Coding Clinics
Ability to work independently and exercise independent judgment
Critical thinking skills
Ability to research coding questions asked by coding and other areas in a timely manner
Knowledge of the Clinical Documentation Management Program
Ability to assist the Documentation Specialist with questions regarding code/DRG assignment
Ability to serve as back up for the Coding Specialist II, Coding Specialist III and Coding Auditor when needed
Ability to make recommendations on coding education and training based on audit results
Maintains AHIMA credentials, CEUs and up to date knowledge of coding guidelines
Associate or Bachelor's degree in AHIMA accredited Health Information Management program with credentialing as a RHIA or RHIT
An AHIMA certified Coding Specialist (CCS) credential may be substituted in lieu of a degree
5 years' experience
Preferred
Prior coding auditor experience
Benefits
Great Benefits
Company
ECU Health
We come to work every day in order to help you and the 1.4 million people like you across eastern North Carolina.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Brian Floyd
President and COO
Betsey Kirisits, PHR
HR Business Partner II
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