Clinical DRG Auditor
Anywhere
Category: Healthcare
Reference ID: 10063634
Shortcut: http://addisongroup.gosnaphop.com/BQrlhP
Job title: Clinical Review Auditor (DRG Auditor)
Location (city, state): Fully Remote (United States) Preference for candidates in Central or Eastern Time zones
Industry: Healthcare Revenue Cycle / Clinical Auditing
Pay: $85,000 – $100,000 annually (salaried), based on experience
Schedule: Full-time, 40 hours per week | No overtime
About Our Client:
Addison Group is hiring on behalf of one of our healthcare clients that specializes in clinical quality, compliance, and revenue integrity. The organization promotes a collaborative, transparent culture and offers long-term growth opportunities for experienced auditors.
Job Description:
The Clinical Review Auditor (DRG Auditor) is responsible for performing comprehensive inpatient DRG audits to ensure accurate coding, clinical validation, and compliant reimbursement. This role requires detailed medical record review, application of ICD-10-CM and ICD-10-PCS guidelines, and clear documentation of audit outcomes. The position is fully remote.
Key Responsibilities:
- Conduct retrospective inpatient DRG audits for coding and clinical validation
- Review medical records to confirm accurate DRG and MS-DRG assignment
- Evaluate clinical documentation to support medical necessity and reimbursement
- Identify coding discrepancies, documentation gaps, and audit trends
- Apply Medicare, Medicaid, and payer-specific regulations during reviews
- Document audit findings clearly, including validated and non-validated results
- Support appeals, rebuttals, and quality initiatives as needed
- Communicate findings effectively with leadership and internal teams
- Maintain compliance with HIPAA and organizational policies
- Work independently while contributing to team coverage and deadlines
Qualifications:
- AHIMA or AAPC credential required (RHIT, CCS, CPC, CCS-P, CIC, or CDIP)
- Strong MS-DRG auditing experience required
- Inpatient facility coding experience with ICD-10-CM and ICD-10-PCS
- Prior clinical audit and retrospective/post-bill review experience
- CDI auditors considered if they possess strong inpatient coding expertise
- RN or LVN background preferred but not required
- APR-DRG experience a plus
- Excellent analytical, critical thinking, and attention-to-detail skills
- Strong verbal and written communication abilities
Additional Details:
- Fully remote role with equipment provided (desktop workstation)
- Training schedule aligns with Eastern Time business hours
- Post-training schedule is Monday–Friday, day shift within Eastern Time coverage
- Fixed schedule required; split shifts and compressed schedules not available
Perks/Benefits:
- Medical, dental, and vision insurance
- 401(k) retirement plan
- Benefits eligibility after 60 days of employment
- Paid time off and separate sick time accrual
- Observed paid holidays, including major federal holidays
- Two floating holidays annually
- PTO carryover available (up to annual cap)
- Monthly internet stipend
- Employer-paid AHIMA certification renewal and CEUs
Addison Group is an Equal Opportunity Employer. Addison Group provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. Addison Group complies with applicable state and local laws governing non-discrimination in employment in every location in which the company has facilities. Reasonable accommodation is available for qualified individuals with disabilities, upon request.
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