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Jobs or company...
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DRG Coding Auditor

  • Full Time, onsite
  • Calpion/Plutus Health
  • Remote On Site, United States of America
Salary undisclosed

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Job Description

Job Description
Salary:

Job Title: DRG Coding Auditor

Location: Dallas / Open to remote

Position Type: Part-Time / Contract.

Immediate Hiring

Plutus Health Inc. is a leading provider of Revenue Cycle Management (RCM) services with SOC2 Certification. We are dedicated to helping healthcare providers improve their financial performance. Our expertise spans across various specialties. We are committed to delivering exceptional service and innovative solutions to our clients. As a result, Plutus Health Inc. has been recognized on the 5000 list of the fastest-growing private companies in America and ranked 100 in the Dallas area. Additionally, the company has been a 2024 finalist in the EY Entrepreneur Of The Year.

Job Summary:

The DRG Coding Auditor is responsible for reviewing and auditing medical records to ensure accurate coding and billing according to Diagnosis-Related Group (DRG) guidelines. The role involves verifying the correctness of codes used for diagnoses and procedures, ensuring compliance with regulatory standards, and identifying opportunities for improvement in coding practices.

Key Responsibilities:

  1. Audit Medical Records:
    • Review patient charts and coding data to ensure the accurate assignment of DRG codes.
    • Verify that all documented diagnoses and procedures are appropriately coded.
  2. Analyze and Validate Codes:
    • Ensure DRG codes are applied correctly based on clinical documentation.
    • Identify discrepancies between documented information and coded data.
  3. Compliance and Quality Assurance:
    • Ensure adherence to coding standards and regulations set by CMS and other regulatory bodies.
    • Monitor and evaluate coding practices for compliance with internal policies and external regulations.
  4. Error Identification and Resolution:
    • Detect and report coding errors, discrepancies, and potential fraud.
    • Work with coding staff and healthcare providers to resolve identified issues.
  5. Feedback and Training:
    • Provide constructive feedback and recommendations for improving coding accuracy.
    • Conduct training sessions and workshops to enhance the skills of coding staff.
  6. Stay Current with Coding Guidelines:
    • Keep abreast of changes in coding practices, DRG classifications, and healthcare regulations.
    • Update internal practices and training materials to reflect new guidelines and standards.
  7. Documentation and Reporting:
    • Maintain accurate records of audits and findings.
    • Prepare detailed reports on audit outcomes and trends for management review.

Qualifications:

  • Education: Bachelor s degree in Health Information Management, Medical Coding, or a related field. Equivalent experience may be considered.
  • Certifications: Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or other relevant certifications preferred.
  • Experience: Minimum of 3-5 years of experience in medical coding, with at least 2 years in DRG coding and auditing.
  • Knowledge: In-depth knowledge of DRG coding systems, medical terminology, and healthcare regulations.
  • Skills:
    • Exceptional attention to detail and analytical skills.
    • Strong communication and interpersonal skills.
    • Ability to work independently and as part of a team.
    • Proficiency in coding software and electronic health record (EHR) systems.

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Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.
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