Job Description
About the position
CGI is seeking a high-caliber MS-DRG Auditor to join our Healthcare Compliance Team. In this role, you will be a key defender of payment accuracy, reviewing complex medical records to ensure that coding and reimbursements for Commercial and Government health plans are precise and well-supported. You will leverage your deep inpatient coding expertise and clinical intuition to identify improper payments while producing thoroughly documented decisions. At CGI, you aren't just an auditor; you are part of a structured professional ecosystem that prioritizes continuous learning, quality management, and career mentorship.
- Responsibilities
- Clinical Record Validation: Review inpatient medical records to validate the assignment and sequencing of ICD-10 codes, discharge status, Hospital Acquired Conditions (HACs), POA assignment, and final DRG.
- Documentation Excellence: Author detailed rationale for every audit finding, producing "DRG Review Results" letters supported by authoritative coding references.
- Collaborative Review: Manage the referral process to Clinical Nurse Auditors or Physician Advisors when clinical complexity requires interdisciplinary input.
- Strategic Input: Partner with our Edit Development team to provide feedback on claim selection criteria and improve audit hit rates.
- Data Integrity: Verify client data, resolve discrepancies, and ensure all audit artifacts meet rigorous corporate and regulatory standards.
- Professionalism: Maintain high standards of productivity and audit quality while serving as a professional representative of CGI when interacting with providers.
- Requirements
- Active AHIMA Credentials: RHIA, RHIT, or CCS required.
- Inpatient Expertise: Minimum of 5 years of inpatient coding experience.
- Deep Subject Matter Expertise: Extensive knowledge of ICD-10-CM/PCS coding and reimbursement methodologies, including MS-DRG and APR-DRG.
- Clinical & Analytical Rigor: Strong clinical validation skills combined with the ability to analyze data for trends in improper payments.
- Communication Mastery: Ability to write well-reasoned, narrative-style reviews with flawless grammar, punctuation, and sentence structure.
- Technical Proficiency: Advanced working knowledge of Microsoft Office (Excel, Word, Outlook) and Windows-based audit applications.
- Self-Directed: Proactive and capable of working independently in a remote environment.
- Adaptable: Resilience to shifting priorities and a commitment to meeting strict client deadlines.
- Growth Mindset: A passion for life-long learning and staying current with evolving coding guidelines.
- Nice-to-haves
- Certification Preference: CCS (Certified Coding Specialist) is highly preferred.
- Previous experience training or mentoring junior-level coders.
- Willingness to travel occasionally for on-site reviews or specialized training.
- Benefits
- Competitive compensation
- Comprehensive insurance options
- Matching contributions through the 401(k) plan and the share purchase plan
- Paid time off for vacation, holidays, and sick time
- Paid parental leave
- Learning opportunities and tuition assistance
- Wellness and Well-being programs
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