Remote Clinical Auditor (Inpatient DRG Auditor)
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.
Essential Responsibilities
• 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
Required Knowledge & Skills
• 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
National Coding Certification Required:
One or more of the following:
• 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
Clinical licensure preferred but not required:
• RN
• LVN/LPN
Experience Requirements:
• 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.
Schedule
• Fully remote within the United States
• Standard business hours
• Full-time production-based role
Interview Process
• 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
Benefits:
• 401(k)
• 401(k) matching
• Flexible schedule
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Parental leave
• Professional development assistance
• Tuition reimbursement
• Vision insurance
Application Question(s):
• Do you have hands-on experience performing DRG validation audits on inpatient medical records?
Experience:
• Medical documentation: 1 year (Preferred)
• DRG: 1 year (Preferred)
License/Certification:
• RN License (Preferred)
Location:
• Remote (Preferred)
Work Location: Remote
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Apply To this Job
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.
Essential Responsibilities
• 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
Required Knowledge & Skills
• 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
National Coding Certification Required:
One or more of the following:
• 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
Clinical licensure preferred but not required:
• RN
• LVN/LPN
Experience Requirements:
• 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.
Schedule
• Fully remote within the United States
• Standard business hours
• Full-time production-based role
Interview Process
• 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
Benefits:
• 401(k)
• 401(k) matching
• Flexible schedule
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Parental leave
• Professional development assistance
• Tuition reimbursement
• Vision insurance
Application Question(s):
• Do you have hands-on experience performing DRG validation audits on inpatient medical records?
Experience:
• Medical documentation: 1 year (Preferred)
• DRG: 1 year (Preferred)
License/Certification:
• RN License (Preferred)
Location:
• Remote (Preferred)
Work Location: Remote
Apply tot his job
Apply To this Job