AAPC
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 has inpatient and outpatient coding/auditing experience focused on: Inpatient MS-DRG/APR-DRG and Outpatient CPT-4/HCPCS coding and auditing, with a strong emphasis on pediatric healthcare services, coding accuracy, and payer claim processing. This is a remote contract position. Job Duties
Review hospital records for clinical supports to validate the accuracy of ICD-10-CM, ICD-10-PCS, DRG/APR group appropriateness, CPT and HCPCS inpatient 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 and report any suspected or actual violation or breach. Extensive knowledge of the healthcare industry and experience in coding, billing, auditing, compliance, and reimbursement for inpatient and outpatient facility services. 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, and 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 DRG assignment, including familiarity with inpatient denial coding systems (e.g., CARC codes). Proficiency in coding software, electronic health record systems, and familiarity with how AI tools can assist in identifying over/under-assigned DRGs. Experience working with technical teams building coding and large language models. High-level proficiency in anatomy, physiology, disease processes, 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, and a proactive work ethic. Qualifications & Certifications
Minimum Requirements as listed in job description: extensive knowledge of healthcare coding, billing, auditing, compliance, and reimbursement for inpatient and outpatient facility services; extensive pediatric inpatient facility experience; strong knowledge of clinical indicators and evidence-based guidelines; 5 years CDI experience with DRG/APR-DRG; familiarity with clinical documentation improvement practices; extensive knowledge of Official Coding Guidelines and Coding Clinic citations; cost reduction and DRG assignment experience; proficiency with coding software and EHRs; experience with AI tools for DRG analysis; experience with technical teams building coding and large language models; high proficiency in anatomy, physiology, disease processes, and pharmacology; detail-oriented and deadline-driven; critical thinking and problem-solving; strong organizational skills and accountability. Certification Requirements: CDIP (AHIMA) or CCDS (ACDIS) OR RHIA, RHIT, or CCS from AHIMA and/or CPMA, CIC, COC from AAPC (Preferred). Attributes
Humble
- Learns, adapts, and improves relentlessly. Seeks feedback and implements coaching. Recognizes others' contributions and collaborates with an abundance mindset. Supportive
- Empowers and uplifts others, listens actively, responds with empathy, and prioritizes team and customer growth. Driven
- Self-starter with initiative, energy, and accountability; balances autonomy with responsibility. Transparent
- Open, trustworthy, and follows through on commitments. Innovative
- Entrepreneurial, collaborative, and capable of delivering results with a scrappy mindset. What We Offer
Compensation commensurate with experience Comprehensive benefits including medical, dental, and vision Health Savings Account Generous PTO and holidays 401(k) retirement plan Remote/virtual-office consideration AAPC is an Equal Opportunity Employer. This company does not discriminate in employment and personnel practices on the basis of race, sex, age, disability, religion, national origin, or any other basis prohibited by law. Hiring, transferring, and promotion practices are performed without regard to these items. Seniority level
Mid-Senior level Employment type
Full-time Job function
Information Technology Industries
Wireless Services, Telecommunications, and Communications Equipment Manufacturing
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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 has inpatient and outpatient coding/auditing experience focused on: Inpatient MS-DRG/APR-DRG and Outpatient CPT-4/HCPCS coding and auditing, with a strong emphasis on pediatric healthcare services, coding accuracy, and payer claim processing. This is a remote contract position. Job Duties
Review hospital records for clinical supports to validate the accuracy of ICD-10-CM, ICD-10-PCS, DRG/APR group appropriateness, CPT and HCPCS inpatient 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 and report any suspected or actual violation or breach. Extensive knowledge of the healthcare industry and experience in coding, billing, auditing, compliance, and reimbursement for inpatient and outpatient facility services. 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, and 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 DRG assignment, including familiarity with inpatient denial coding systems (e.g., CARC codes). Proficiency in coding software, electronic health record systems, and familiarity with how AI tools can assist in identifying over/under-assigned DRGs. Experience working with technical teams building coding and large language models. High-level proficiency in anatomy, physiology, disease processes, 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, and a proactive work ethic. Qualifications & Certifications
Minimum Requirements as listed in job description: extensive knowledge of healthcare coding, billing, auditing, compliance, and reimbursement for inpatient and outpatient facility services; extensive pediatric inpatient facility experience; strong knowledge of clinical indicators and evidence-based guidelines; 5 years CDI experience with DRG/APR-DRG; familiarity with clinical documentation improvement practices; extensive knowledge of Official Coding Guidelines and Coding Clinic citations; cost reduction and DRG assignment experience; proficiency with coding software and EHRs; experience with AI tools for DRG analysis; experience with technical teams building coding and large language models; high proficiency in anatomy, physiology, disease processes, and pharmacology; detail-oriented and deadline-driven; critical thinking and problem-solving; strong organizational skills and accountability. Certification Requirements: CDIP (AHIMA) or CCDS (ACDIS) OR RHIA, RHIT, or CCS from AHIMA and/or CPMA, CIC, COC from AAPC (Preferred). Attributes
Humble
- Learns, adapts, and improves relentlessly. Seeks feedback and implements coaching. Recognizes others' contributions and collaborates with an abundance mindset. Supportive
- Empowers and uplifts others, listens actively, responds with empathy, and prioritizes team and customer growth. Driven
- Self-starter with initiative, energy, and accountability; balances autonomy with responsibility. Transparent
- Open, trustworthy, and follows through on commitments. Innovative
- Entrepreneurial, collaborative, and capable of delivering results with a scrappy mindset. What We Offer
Compensation commensurate with experience Comprehensive benefits including medical, dental, and vision Health Savings Account Generous PTO and holidays 401(k) retirement plan Remote/virtual-office consideration AAPC is an Equal Opportunity Employer. This company does not discriminate in employment and personnel practices on the basis of race, sex, age, disability, religion, national origin, or any other basis prohibited by law. Hiring, transferring, and promotion practices are performed without regard to these items. Seniority level
Mid-Senior level Employment type
Full-time Job function
Information Technology Industries
Wireless Services, Telecommunications, and Communications Equipment Manufacturing
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