Drg Validation Auditor
Pubblicato il 16-10-2026 - SFNet in Emilia-Romagna
h3Role and Responsibilities /h3pNon è affidabile/a delle competenze necessarie per questa opportunità? Legga la descrizione completa qui sotto per avere un quadro completo dei requisiti richiesti. /ppThe 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. /pulliConducts 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 DRGbr/ /liliAppropriately 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 Clinicsbr/ /liliWrites complete, clear, and accurate rationale to support audit determinations, citing specific information from the record, and referencing appropriate guidelines, policies, regulations, and/or Coding advicebr/ /liliKeeps abreast of coding, clinical, regulatory, and other industry changes that impact Penstock auditing and/or that suggest new audit opportunitiesbr/ /liliMaintains focus on the identification and development of new audit conceptsbr/ /liliContinuously considers the systems and processes involved with healthcare reimbursement (both internal and external) and communicates ideas for improvement through appropriate channelsbr/ /liliParticipates in focused training to learn new auditing skills across a myriad of clinical and coding scenariosbr/ /liliCommunicates kindly, professional