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Certified DRG Claims Auditor
A company is looking for a DRG Claims Auditor, Recoveries. Key Responsibilities Perform DRG validation and quality audits on claims, focusing on overpayment identification Utilize clinical knowledge to ensure accurate ICD-10-CM/PCS code assignments and compliance with guidelines Review and analyze claims to support medical policies and identify billing trends for potential recoveries Required Qualifications Associate's degree required; Bachelor's degree preferred Certification as a Certified Inpatient Coder (CIC), Certified Professional Coder (CPC), or similar 5+ years of experience in DRG validation or claims auditing Thorough knowledge of ICD-10, CPT, HCPCS, and Revenue Billing Codes Nursing license preferred
A company is looking for a DRG Claims Auditor, Recoveries.
Key Responsibilities
Perform DRG validation and quality audits on claims, focusing on overpayment identification
Utilize clinical knowledge to ensure accurate ICD-10-CM/PCS code assignments and compliance with guidelines
Review and analyze claims to support medical policies and identify billing trends for potential recoveries
Required Qualifications
Associate's degree required; Bachelor's degree preferred
Certification as a Certified Inpatient Coder (CIC), Certified Professional Coder (CPC), or similar
5+ years of experience in DRG validation or claims auditing
Thorough knowledge of ICD-10, CPT, HCPCS, and Revenue Billing Codes
Nursing license preferred
