DRG Validation Coding Auditor

📋 Description

• • The DRG Validation Coding Auditor performs documentation and coding audits for all acute inpatient services for clients, identifying coding errors, compliance issues, and educational opportunities to optimize reimbursement by ensuring diagnosis/procedure codes and supporting documentation accurately reflect services rendered and comply with ethical coding standards and regulatory requirements.
• • Day to day, the auditor conducts DRG (MS, APR, Tricare) coding and clinical reviews to verify coding accuracy, DRG assignment, and clinical indicators; assesses whether clinical documentation supports coded diagnoses and procedures; writes clear, accurate, and concise recommendations referencing ICD-10-CM/PCS Official Coding Guidelines and AHA Coding Clinics; uses proprietary systems and encoder tools efficiently; maintains productivity and quality goals; and identifies potential overpayments or underpayments through 30-day lookback analyses.
• • Ensemble Health Partners LLC is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups, offering end-to-end revenue cycle solutions and a comprehensive suite of point solutions nationwide. The company is recognized for its award-winning culture, including five-time "Best in KLAS" winner (2020-2022, 2024-2025), Black Book Research’s Top Revenue Cycle Management Outsourcing Solution (2021-2024), and Great Place to Work certified (2023-2024), with a mission to keep communities healthy by keeping hospitals healthy through meaningful human touch and empowerment of its people.
• • In this role, the person can deepen expertise in inpatient/DRG validation coding, advance proficiency in multiple EMRs and encoder tools, strengthen communication and collaboration with CDI specialists, stay current with evolving coding guidelines and reimbursement policies, pursue professional certifications with company support, and contribute to process improvements and compliance initiatives while enjoying career advancement opportunities through tuition reimbursement and recognition programs.