Review medical records and associated claim information to validate accuracy of DRG assignments and/or Itemized Billing
Utilize coding guidelines to perform DRG validation
Validate principal diagnosis, secondary diagnoses, sequencing of diagnoses, discharge statuses and procedures utilizing the medical record
Apply CPT and ICD-10 guidelines
Validate itemized bill payments utilizing the UB-04, the itemized bill and industry/client coding guidelines
Provide appeal responses for claims utilizing industry standards and company/client policies
Maintain certifications and continuing education requirements

Coding certification in good standing. Examples: CCS, CPC, CIC
Coding validation/auditing experience
Well-developed verbal and written communication skills coupled with recognizable organization
Ability to effectively prioritize tasks
Microsoft Office experience, specifically Excel

Coder, DRG Auditor I

Key skills