Clinical DRG Auditor
About this role
About the Role Gainwell is seeking a Clinical DRG Auditor to perform DRG validation reviews of medical records and documentation to validate the conditions, ICD-10-CM/PCS code assignments, and the accuracy of DRG assignments as defined by contract-specific review methodologies. This role requires extensive clinical experience auditing medical records and a strong understanding of payment methodologies including MS-DRG, AP-DRG, and APR-DRG. The auditor will access proprietary systems, document audit findings, and provide policy/regulatory support for determinations.
What You'll Do
- Perform audits of medical record documentation to determine the accuracy of principal and secondary diagnoses (including MCC & CC) and procedure codes.
- Adhere to official coding guidelines, Coding Clinics, and regulatory guidelines.
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