Pivotal Placement Services, Inc
DRG Coder / Clinical Auditor
Pivotal Placement Services, Inc, New York, New York, United States
DRG Coder / Clinical Auditor
Remote | Full-Time
|
Healthcare | Clinical Documentation & Coding
About the Role We’re 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. You’ll work independently to review records, validate coding, and communicate findings clearly and professionally.
Key Responsibilities Chart Review & Validation Review medical records to validate DRG assignments and ensure clinical documentation supports coding decisions. Physician Documentation Review Confirm that physician notes and clinical indicators support assigned DRGs. Audit & Compliance Conduct audits to verify coding accuracy, enhance reimbursement, and identify cost-saving opportunities. Coding Expertise Apply ICD-10-CM and PCS coding guidelines, payer rules, and regulatory standards (Medicare, Medicaid, CMS). Communication & Reporting Clearly document findings and communicate results in a professional and concise manner. 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 preferred. CDI candidates are encouraged to apply.
Certifications : National coding certification through AHIMA (preferred) or AAPC. CCS or CIC strongly REQUIRED.
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 professionals—from staff to leadership—with 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.
|
Healthcare | Clinical Documentation & Coding
About the Role We’re 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. You’ll work independently to review records, validate coding, and communicate findings clearly and professionally.
Key Responsibilities Chart Review & Validation Review medical records to validate DRG assignments and ensure clinical documentation supports coding decisions. Physician Documentation Review Confirm that physician notes and clinical indicators support assigned DRGs. Audit & Compliance Conduct audits to verify coding accuracy, enhance reimbursement, and identify cost-saving opportunities. Coding Expertise Apply ICD-10-CM and PCS coding guidelines, payer rules, and regulatory standards (Medicare, Medicaid, CMS). Communication & Reporting Clearly document findings and communicate results in a professional and concise manner. 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 preferred. CDI candidates are encouraged to apply.
Certifications : National coding certification through AHIMA (preferred) or AAPC. CCS or CIC strongly REQUIRED.
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 professionals—from staff to leadership—with 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.