The analyst serves as a subject matter expert developing and validating selection logic to identify coding and billing errors in healthcare claims. They perform data mining and production audits to improve audit yield and ensure alignment with payment integrity objectives.
Penstock Grp.
2 Remote Job Openings at Penstock Grp.
The DRG Validation Auditor reviews inpatient claims and medical records to ensure DRG accuracy based on coding conventions and guidelines. They are responsible for writing clear rationales for audit determinations and identifying new audit concepts to improve payment integrity.
