DRG Coder / Clinical Auditor

DRG Coder / Clinical Auditor

Remote | Full-Time | Healthcare | Clinical Documentation & Coding

About the Role

Were seeking a detail-oriented DRG Coder/Clinical Auditor to perform DRG validation reviews of medical records and documentation. This role ensures accurate coding and clinical support for DRG assignments, helping improve billing accuracy, reimbursement, and compliance. Youll work independently to review records, validate coding, and communicate findings clearly and professionally.

Key Responsibilities

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  Chart Review & Validation
  Review medical records to validate DRG assignments and ensure clinical documentation supports coding decisions.

  
  




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  Physician Documentation Review
  Confirm that physician notes and clinical indicators support assigned DRGs.

  
  




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  Audit & Compliance
  Conduct audits to verify coding accuracy, enhance reimbursement, and identify cost-saving opportunities.

  
  




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  Coding Expertise
  Apply ICD-10-CM and PCS coding guidelines, payer rules, and regulatory standards (Medicare, Medicaid, CMS).

  
  




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  Communication & Reporting
  Clearly document findings and communicate results in a professional and concise manner.

  
  




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  Other Duties
  Support additional documentation and coding-related tasks as assigned.

  
  

Qualifications

• Licensure: RN or LPN/LVN license required or RHIT credential for non-nurses.




• Experience:
  
  
  
  • Minimum 1 year of recent DRG auditing experience in a hospital or health plan setting.

  
  

  • Inpatient ICD-10 coding experience required.

  
  

  • CDI candidates are encouraged to apply.

  
  

  
  




• Certifications:
  
  
  
  • National coding certification through AHIMA (preferred) or AAPC.

  
  

  • CCS or CIC strongly preferred.

  
  

  
  




• Technical Skills:
  
  
  
  • Proficient in MS and APR DRG methodology.

  
  

  • Familiarity with Coding Clinic citations and Official Coding Guidelines.

  
  

  • Strong understanding of Medicare/CMS documentation requirements.

  
  

  
  




• Soft Skills:
  
  
  
  • Exceptional attention to detail.

  
  

  • Strong problem-solving and critical thinking abilities.

  
  

  • Effective verbal and written communication.

  
  

  • Ability to work independently in a fast-paced, production-driven environment.

  
  

  
  




• Tools:
  
  
  
  • Proficient in Microsoft Office Suite.

  
  

  
  

Compensation

Pay Range: $90,000 $104,841
Salary is based on location, experience, qualifications, and internal equity. Final compensation may vary depending on assessment during the interview process.

Who We Are

Headquartered in Central Florida, Pivotal Placement Services is a full-service national workforce solutions firm that specializes in placing healthcare professionalsfrom staff to leadershipwith both clinical and non-clinical employers. Our comprehensive and customer-focused workforce solutions include Direct Placement and Managed Service Provider (MSP) / Vendor Managed Services (VMS) engagements nationwide.