Drg Validation Auditor
Pubblicato il 05-10-2026 - SFNet in Italia
Role and Responsibilities
The DRG Validation Auditor is a valued member of the Penstock Audit team, responsible for reviewing inpatient claims and ensuring that the DRG paid is fair and accurate, based on the documentation in the medical record and the application of ICD-10-CM and ICD-10-PCS coding conventions, instructions, guidelines, policies, and Coding Clinic advice.
The DRG Validation Auditor upholds the standards of honesty, excellence, and innovation that are central to the Penstock mission.
Conducts thorough, thoughtful reviews of healthcare claims and medical records to identify discrepancies between the physician documentation, the clinical picture depicted in the record, the codes billed, and the resulting DRG
Appropriately uses industry-recognized references to support review findings, including the ICD-10-CM and ICD-10-PCS Official Guidelines for Coding and Reporting, AHIMA Standards of Ethical Coding, AHIMA Practice Briefs related to compliant querying, and AHA Coding Clinics
Writes complete, clear, and accurate rationale to support audit determinations, citing specific information from the record, and referencing appropriate guidelines, policies, regulations, and/or Coding advice
Keeps abreast of coding, clinical, regulatory, and other industry changes that impact Penstock auditing and/or that suggest new audit opportunities
Maintains focus on the identification and development of new audit concepts
Continuously considers the systems and processes involved with healthcare reimbursement (both internal and external) and communicates ideas for improvement through appropriate channels
Participates in focused training to learn new auditing skills across a myriad of clinical and coding scenarios
Communicates kindly, professionally, and effectively with all customers, both internal and external, and refers issues to management as appropriate
Continuously strives to find new avenues for fulfilling the Penstock mission of reclaiming greater integrity between payors and providers
Serves as a Payment Integrity subject matter expert for Penstock team members and for the Goodroot organization as a whole
Meets or exceeds Penstock's performance and quality standards.
Senior Auditor positions provide support for Team Lead as required.
Penstock is a service partner and SaaS builder for forward-thinking health plans and providers, empowering recovery, audit, and regulatory teams to get accuracy right from the start—when it matters most.
Our mission is to create lasting systemic change that removes wasted spend from our healthcare system, returning dollars to payers, lowering the cost of care, and improving access for all.
Our business model is rooted in transparency and the drive to reinstate true integrity in payment integrity—even if it defies traditional business sense.
We geek out over building and perfecting software that helps health plans succeed, but we also understand the irreplaceable value of human intelligence.
Qualifications and Education Requirements
Minimum of an associate degree
Current AHIMA Health Information Management credential(s): RHIT or RHIA
Current AHIMA/AAPC Coding Credential: CCS or CIC
Current Clinical Validation credential(s): CDIP, CCDS, or CDEI
3 or more years of ICD-10 inpatient coding experience
1 or more years of clinical experience in a healthcare facility setting
3 or more years of auditing experience (or demonstrated equivalent)
1 or more years of auditing experience in a payor setting
1 or more years of experience in Inpatient Rehabilitation coding/auditing
1 or more years of experience in Inpatient Psychiatric coding/auditing
Comprehensive understanding of ICD-10-CM Inpatient Coding Guidelines, AHA Coding Clinic, and DRG grouping mechanics
Strong current clinical knowledgebase
Familiarity with Clinical Documentation Integrity practices
Awareness of and adherence to HIPAA, and all laws regarding the safeguarding of PHI/PII
Ability to conduct independent research using credible sources
Demonstrated working knowledge of Microsoft Word, Excel, and PowerPoint
Ability to apply critical thinking skills to record reviews
Ability to work independently, manage workload, and adapt to shifting priorities
Willingness to adapt and learn new auditing skills across a myriad of coding and clinical scenarios
Excellent communication skills, both oral and written
Comfortable working in an ever-changing fast paced environment
Able to work Eastern time zone hours
Secure and private home office with reliable high-speed internet connection
Preferred Skills
Bachelor's degree
AHIMA/AAPC/ACDIS Auditing Credential: Auditing: Inpatient Coding Microcredential through AHIMA, Certified Professional Medical Auditor (CPMA) through AAPC
5+ years of inpatient ICD-10 coding and auditing experience
5+ years of relevant auditing (clinical validation and medical necessity) experience
AHIMA/AAPC Coding Certifications (RHIA, RHIT, CCS, CPC, CPC-H), AHIMA/ACDIS Clinical Documentation Certification (CDIP, CCDS), or Clinical Documentation Integrity experience
1-5 years of Inpatient Rehabilitation Coding/Auditing
1-5 years of Inpatient Psychiatric Coding/Auditing
Penstock is an affiliate company of Goodroot, which launches and grows companies dedicated to putting patients back in the center of healthcare.
Penstock is an Equal Opportunity Employer.
About Goodroot
Goodroot is a community of companies committed to delivering more access to better healthcare at a lower cost.
With a growing group of brands including, but not limited to Penstock, Navion, and Emry, Goodroot is reshaping healthcare for good, one system at a time.
Learn more at .
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