The DRG Validation Auditor reviews inpatient claims to ensure accuracy based on medical documentation and coding conventions. They also serve as a subject matter expert to identify audit opportunities and improve payment integrity processes.
The Team Lead oversees the quality and delivery of complex inpatient coding and clinical validation audits while supervising and mentoring a team of auditors. They are responsible for conducting second-level reviews, managing client deliverables, and ensuring compliance with CMS regulations and coding guidelines.
The Senior Concept and Edit Analyst develops, validates, and improves claim selection logic to ensure accuracy in payment integrity. This role involves conducting data mining, performing production audits, and collaborating with cross-functional teams to identify and resolve billing and coding errors.
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.
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.
