PRN DRG Revenue Integrity Auditor

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a PRN DRG Revenue Integrity Auditor based in the United States. This part-time, remote role focuses on ensuring the accuracy, integrity, and compliance of inpatient clinical coding and reimbursement data. You’ll perform detailed DRG validation and quality audits across medical records, evaluating whether coded information accurately reflects each patient’s clinical picture. The position combines advanced coding knowledge, clinical documentation expertise, regulatory awareness, and analytical judgment. You’ll assess ICD-10-CM/PCS coding, POA indicators, SOI/ROM, HCC capture, and other reimbursement-related elements. Your work will help identify coding opportunities, strengthen documentation practices, and support accurate reimbursement. You’ll collaborate with internal teams and clients while managing multiple projects and maintaining high standards of confidentiality. The role is well suited to an experienced DRG auditor or clinical documentation professional who thrives in an independent, quality-driven environment. Perform DRG validation and quality audits of inpatient medical records to assess coding accuracy, completeness, and clinical validity. Review ICD-10-CM/PCS code assignment and sequencing, POA indicators, SOI/ROM, HCC capture, case-related coding factors, and other elements affecting reimbursement. Confirm that coded data accurately reflects the patient’s documented clinical condition and complies with applicable federal regulations and organizational standards. Analyze medical records to identify potential clinical documentation and physician query opportunities and validate appropriate coding and sequencing. Conduct audits of Clinical Documentation Integrity (CDI) programs when assigned. Apply current official coding guidelines, CDI best practices, CMS guidance, NCDs/LCDs, payer clinical policies, and recognized clinical criteria such as MCG and InterQual. Stay current with changes to coding regulations, clinical guidance, coding clinics, and industry standards. Support internal and client-facing reporting, project analysis, feedback, and quality improvement initiatives. Provide training, shadowing, and subject-matter support to new team members when requested, and contribute to training materials and policy updates. Maintain strict confidentiality of protected health information (PHI) and client information while complying with privacy, security, and access requirements. Build professional relationships with colleagues and clients and communicate findings clearly and effectively. Meet or exceed assigned productivity, accuracy, and quality expectations across projects and record types. Manage multiple clients and projects, adapt to changing priorities, and maintain organized records in a fast-paced environment. Participate in required meetings, training, continuing education, and other activities assigned by management. Requirements: 5+ years of experience working in an acute care setting or with a third-party healthcare vendor as a DRG Auditor or Clinical Documentation Specialist (CDS). Prior experience as a CDI or coding auditor is preferred but not required. Strong knowledge of inpatient DRG validation, ICD-10-CM/PCS coding, clinical documentation, reimbursement principles, and applicable regulatory requirements. Familiarity with POA indicators, SOI/ROM, HCC capture, sequencing, and identifying clinically supported query opportunities. Working experience with electronic medical record (EMR) systems and the ability to operate effectively in a remote environment. Strong analytical skills, including comfort reviewing complex clinical information and working with numerical and reimbursement-related data. Ability to interpret and apply official coding guidance, clinical criteria, payer policies, and CMS requirements. Proficiency with Microsoft Word, Excel, Outlook, Teams, and other standar