AAPC
This is a remote contract position.
Overview We are seeking an experienced DRG Validation Auditor with strong CDI expertise to perform documentation and coding reviews that will support the development of our AI-driven auditing platform. The Auditor will collaborate with clinicians, engineers, product managers, and domain experts to validate data quality and ensure accurate coding practices. This role offers the opportunity to influence the next generation of auditing software while working in a dynamic environment with a high-performing, cross-functional team.
The ideal candidate for this position needs to have both an inpatient and outpatient coding / auditing background focused on the following disciplines from a coding and billing perspective: Inpatient MS-DRG/APR-DRG, and Outpatient CPT-4/HCPCS coding and auditing, with a strong focus on pediatric healthcare services and coding accuracy and payer claim processing.
Job Duties
Review hospital records for clinical supports to validate the accuracy of ICD-10-CM, ICD-10-PCS, and DRG and APR group appropriateness, CPT and HCPCS inpatient patient and outpatient facility claims. Identify codes that may have been over or under assigned, ensuring accurate reimbursement aligned with regulatory and contractual guidelines.
Identify and resolve complex coding discrepancies.
Write technical rationales for correct clinical, documentation and code changes.
Communicate complex coding findings to project lead and other cross functional teams.
Be responsible and accountable for maintaining confidentiality, integrity, and availability of protected health information. Follow HIPAA security policies and procedures affecting your job, and report any suspected or actual violation or breach.
Minimum Requirements
Extensive knowledge of healthcare industry and experience in and around coding, billing, auditing, compliance and reimbursement for Inpatient and Outpatient facility.
Must have extensive pediatric inpatient facility experience.
Strong knowledge of clinical indicators, diagnostic criteria, and evidence-based guidelines to support accurate code assignment.
5 years of CDI expertise in facility inpatient and outpatient services with DRG and APR-DRG as well as familiarity with clinical documentation improvement practices.
Extensive knowledge of current Official Coding Guidelines and Coding Clinic citations.
Strong background in cost reduction strategies by ensuring correct claims payment and appropriate diagnosis-related group (DRG) assignment including familiarity with inpatient denial coding systems (e.g. CARC codes).
Proficiency in coding software, electronic health record systems and familiar with how AI tools can assist in identifying over/under-assigned DRGs.
Experience in working with technical teams building coding and large language models.
High level proficiency in anatomy, physiology, disease process, and pharmacology.
Detail oriented and deadline driven attitude.
Ability to think critically and determine the best method for resolving challenges.
Strong organizational skills, a strong sense of accountability, a proactive work ethic.
Certification Requirements
CDIP (AHIMA) or CCDS (ACDIS)
RHIA, RHIT, or CCS from AHIMA and/or CPMA, CIC, COC from AAPC preferred
Attributes
Humble
– Learns, adapts, and improves relentlessly. Seeks feedback without insecurity and implements coaching. Recognizes others' contributions gratefully. Approaches work and relationships with an abundance mentality. Places the needs of others above self.
Supportive
– Empowers and uplifts others. Listens actively and responds with empathy and understanding. Prioritizes well-being and growth of team members and customers ahead of own interest. Faces challenges together.
Driven
– Self-starts and stays highly motivated to achieve ambitious goals. Takes initiative and demonstrates confidence in decision-making while balancing autonomy with accountability.
Transparent
– Follows through on commitments and maintains accountability. Values trust and integrity.
Innovative
– Entrepreneurial spirit with a scrappy mentality. Seeks opportunities, pursues potential, and executes efficiently.
What we Offer
Compensation commensurate with experience
Comprehensive benefits package including medical, dental and vision insurance
Health Savings Account
Generous PTO and Holiday Pay
401(k) retirement plan
Remote/virtual-office consideration
AAPC is an Equal Opportunity Employer. This company does not and will not discriminate in employment and personnel practices on the basis of race, sex, age, disability, religion, national origin or any other basis prohibited by applicable law. Hiring, transferring and promotion practices are performed without regard to the above-listed items.
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Overview We are seeking an experienced DRG Validation Auditor with strong CDI expertise to perform documentation and coding reviews that will support the development of our AI-driven auditing platform. The Auditor will collaborate with clinicians, engineers, product managers, and domain experts to validate data quality and ensure accurate coding practices. This role offers the opportunity to influence the next generation of auditing software while working in a dynamic environment with a high-performing, cross-functional team.
The ideal candidate for this position needs to have both an inpatient and outpatient coding / auditing background focused on the following disciplines from a coding and billing perspective: Inpatient MS-DRG/APR-DRG, and Outpatient CPT-4/HCPCS coding and auditing, with a strong focus on pediatric healthcare services and coding accuracy and payer claim processing.
Job Duties
Review hospital records for clinical supports to validate the accuracy of ICD-10-CM, ICD-10-PCS, and DRG and APR group appropriateness, CPT and HCPCS inpatient patient and outpatient facility claims. Identify codes that may have been over or under assigned, ensuring accurate reimbursement aligned with regulatory and contractual guidelines.
Identify and resolve complex coding discrepancies.
Write technical rationales for correct clinical, documentation and code changes.
Communicate complex coding findings to project lead and other cross functional teams.
Be responsible and accountable for maintaining confidentiality, integrity, and availability of protected health information. Follow HIPAA security policies and procedures affecting your job, and report any suspected or actual violation or breach.
Minimum Requirements
Extensive knowledge of healthcare industry and experience in and around coding, billing, auditing, compliance and reimbursement for Inpatient and Outpatient facility.
Must have extensive pediatric inpatient facility experience.
Strong knowledge of clinical indicators, diagnostic criteria, and evidence-based guidelines to support accurate code assignment.
5 years of CDI expertise in facility inpatient and outpatient services with DRG and APR-DRG as well as familiarity with clinical documentation improvement practices.
Extensive knowledge of current Official Coding Guidelines and Coding Clinic citations.
Strong background in cost reduction strategies by ensuring correct claims payment and appropriate diagnosis-related group (DRG) assignment including familiarity with inpatient denial coding systems (e.g. CARC codes).
Proficiency in coding software, electronic health record systems and familiar with how AI tools can assist in identifying over/under-assigned DRGs.
Experience in working with technical teams building coding and large language models.
High level proficiency in anatomy, physiology, disease process, and pharmacology.
Detail oriented and deadline driven attitude.
Ability to think critically and determine the best method for resolving challenges.
Strong organizational skills, a strong sense of accountability, a proactive work ethic.
Certification Requirements
CDIP (AHIMA) or CCDS (ACDIS)
RHIA, RHIT, or CCS from AHIMA and/or CPMA, CIC, COC from AAPC preferred
Attributes
Humble
– Learns, adapts, and improves relentlessly. Seeks feedback without insecurity and implements coaching. Recognizes others' contributions gratefully. Approaches work and relationships with an abundance mentality. Places the needs of others above self.
Supportive
– Empowers and uplifts others. Listens actively and responds with empathy and understanding. Prioritizes well-being and growth of team members and customers ahead of own interest. Faces challenges together.
Driven
– Self-starts and stays highly motivated to achieve ambitious goals. Takes initiative and demonstrates confidence in decision-making while balancing autonomy with accountability.
Transparent
– Follows through on commitments and maintains accountability. Values trust and integrity.
Innovative
– Entrepreneurial spirit with a scrappy mentality. Seeks opportunities, pursues potential, and executes efficiently.
What we Offer
Compensation commensurate with experience
Comprehensive benefits package including medical, dental and vision insurance
Health Savings Account
Generous PTO and Holiday Pay
401(k) retirement plan
Remote/virtual-office consideration
AAPC is an Equal Opportunity Employer. This company does not and will not discriminate in employment and personnel practices on the basis of race, sex, age, disability, religion, national origin or any other basis prohibited by applicable law. Hiring, transferring and promotion practices are performed without regard to the above-listed items.
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