DRG Auditor

PLEASE NOTE BEFORE APPLYING: CODOXO IS NOT ABLE TO OFFER SPONSORSHIP OR ACCOMMODATE ANY CANDIDATES THAT ARE CURRENTLY BEING SPONSORED NOW OR IN THE FUTURE Of the $3.8T we spend on healthcare in the United States annually, about a third of it is estimated to be lost due to waste, fraud and abuse. Codoxo is the premier provider of artificial intelligence-driven solutions and services that help healthcare companies and agencies proactively detect and reduce risks from fraud, waste, and abuse and ensure payment integrity. Codoxo helps clients manage costs across network management, clinical care, provider coding and billing, payment integrity, and special investigation units. Our software-as-a service applications are built on our proven Forensic AI Engine, which uses patented AI-based technology to identify problems and suspicious behavior far faster and earlier than traditional techniques. We are venture backed by some of the top investors in the country, with strong financials, and remain one of the fastest growing healthcare AI companies in the industry. Position Summary: As a DRG Auditor, you will perform detailed medical records and coding reviews to validate DRG assignments, ensure appropriate reimbursement, and maintain compliance with national coding guidelines and payer policies. This role focuses strictly on coding accuracy and documentation of sufficiency and supports payment integrity efforts by identifying coding discrepancies and opportunities to recover improper payments. Key Responsibilities: Conduct MS-DRG and APR-DRG validation audits to confirm accurate DRG assignment and reimbursement Review inpatient medical records to validate: Principal diagnosis Secondary diagnoses (CC/MCC capture) Procedures (ICD-10-PCS) Discharge disposition Apply ICD-10-CM/PCS Official Guidelines and AHA Coding Clinic guidance Identify coding inaccuracies, documentation gaps, and potential overpayments through retrospective audits Develop clear, well-supported audit findings with defensible coding rationale Quantify financial impact of coding discrepancies and support recovery efforts Utilize tools such as 3M, WebStrat, or similar DRG encoder platforms Maintain compliance with payer policies and internal audit methodologies Collaborate with payment integrity analysts, auditors, and data teams Participate in special projects related to inpatient coding integrity Maintain productivity and quality benchmarks Scope Clarification This role is coding-focused only May perform clinical validation reviews if qualified Relies on provider documentation as written (no independent clinical challenge of diagnoses) Qualifications: Associate or bachelor’s degree in health information management or related field preferred Required: CCS, RHIT, RHIA, or similar coding credential RN, LPN or other clinical credentials preferred 3+ years of inpatient coding experience Strong knowledge of MS-DRG and APR-DRG assignment Experience with retrospective DRG validation audits preferred Experience in payment integrity, audit vendors, or revenue cycle teams highly desirable Expert knowledge of ICD-10-CM/PCS and DRG methodologies Strong analytical and documentation review skills Ability to produce defensible, audit-ready findings Attention to detail and regulatory compliance focus Proficiency in encoder tools and Microsoft Office Physical Requirements: Work is performed in an office environment (either in our office or work-from home) and requires the ability to work on a computer, operate standard office equipment, and work at a desk. Accessibility Notice: If you need reasonable accommodation for any part of the employment process due to a physical or mental disability, please send an email to [email protected] with the subject "Accommodation". Reasonable accommodation requests will be considered on a case-by-case basis. Benefits for You Health, Dental, and Vision insurance with 100% employee premium coverage (Starts Day 1) Unlimited PTO Annual Professional Development stipend Annual home office stipend 401K Match (after 90 days) We are an Equal Opportunity Employer: Codoxo provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment. Apply To This Job