Remote Clinical Auditor (Inpatient DRG Auditor)

🌍 Remote, USA 🎯 Full-time 🕐 Posted Recently

Job Description

DRG Clinical Auditor

Remote – United States

Industry: Healthcare | Clinical Audit | Revenue Integrity
Employment Type: Full-Time

Company Overview

TalentLNX is partnering with a confidential healthcare organization seeking an experienced DRG Clinical Auditor to support inpatient DRG validation initiatives.

This organization conducts complex medical record audits to ensure documentation accuracy, reimbursement integrity, and compliance with federal and payer-specific regulations across Medicare, Medicaid, and commercial populations.

Position Summary

The DRG Clinical Auditor is responsible for conducting detailed reviews of inpatient medical records to validate coding accuracy and confirm appropriate DRG assignment.

This role requires advanced knowledge of MS-DRG and APR-DRG methodologies, strong ICD-10-CM and ICD-10-PCS expertise, and the ability to determine whether clinical documentation supports the assigned reimbursement structure.

The ideal candidate combines inpatient clinical knowledge with advanced coding proficiency and produces defensible, clearly documented audit findings in a production-driven remote environment.

Perform comprehensive inpatient medical record reviews for MS-DRG and APR-DRG validation
Evaluate coding accuracy using ICD-10-CM and ICD-10-PCS Official Guidelines
Confirm documentation supports principal diagnosis, secondary diagnoses, procedures, and assigned DRGs
Validate CC and MCC capture based on clinical indicators and documentation support
Apply CMS regulations, NCD/LCD policies, and payer-specific guidelines during review
Identify discrepancies and document findings with clear, defensible clinical rationale
Support appeal and rebuttal processes when required
Maintain strict compliance with HIPAA and internal audit policies
Communicate findings professionally and escalate trends or concerns to leadership

Advanced knowledge of ICD-10-CM and ICD-10-PCS coding guidelines
Strong understanding of MS-DRG grouping methodology
Familiarity with APR-DRG logic preferred
Experience applying CMS and payer audit rules in determinations
Working knowledge of Coding Clinic guidance
Experience using encoder platforms such as 3M 360 or equivalent tools
Demonstrated ability to maintain 95 percent or higher audit accuracy
Strong written documentation skills
Ability to work independently in a remote production setting

Education, Licensure & Certification Requirements

CCS (Certified Coding Specialist)
RHIA (Registered Health Information Administrator)
RHIT (Registered Health Information Technician)
CDIP (Certified Documentation Improvement Practitioner)
CIC, CPC, or CPC-H with strong inpatient DRG experience

RN
LVN/LPN

Minimum 3+ years of recent inpatient DRG audit experience
Hands-on ICD-10-CM and ICD-10-PCS coding experience
Full-scope inpatient DRG validation background required

Compensation

Salary Range: $75,000 – $100,000 annually

Compensation is determined based on experience, certification level, clinical background, production performance history, and internal equity considerations.

Fully remote within the United States
Standard business hours
Full-time production-based role

TalentLNX screening
Client leadership interview
Final review and offer discussion

Process steps may vary.

Equal Opportunity Statement

TalentLNX and our client partners are Equal Opportunity Employers. Qualified applicants will be considered without regard to legally protected characteristics.

Pay: $75,000.00 - $100,000.00 per year