DRG Validation Auditor I

R1rcm is hiring a full-time DRG Validation Auditor I for a remote position based in the USA. This role focuses on ensuring the accuracy and compliance of diagnosis-related group coding and billing data across healthcare claims.

What This Role Involves

As a DRG Validation Auditor I, you'll play a critical part in maintaining the integrity of healthcare billing and coding compliance. You'll review medical records and related documentation to validate that diagnoses and procedures are correctly coded and classified according to DRG standards. This position requires attention to detail, knowledge of healthcare coding principles, and the ability to identify discrepancies that could impact billing accuracy and regulatory compliance.

Your Responsibilities

• Audit medical records and claims data to verify accurate DRG code assignment
• Compare submitted documentation against coding guidelines and compliance requirements
• Identify coding errors, missing documentation, and billing discrepancies
• Prepare detailed audit findings and recommendations for remediation
• Maintain organized records of reviewed claims and audit outcomes
• Communicate findings with relevant teams to support quality improvement initiatives
• Stay current with DRG coding updates and healthcare billing regulations

Qualifications

• High school diploma or equivalent; some college education or related certification preferred
• Knowledge of medical coding, healthcare billing, or related healthcare operations
• Strong analytical and attention-to-detail skills
• Proficiency with computer systems and data review software
• Ability to work independently and meet performance expectations
• Excellent communication and organizational skills

More About R1rcm

R1rcm is a healthcare revenue cycle management company focused on helping healthcare organizations optimize their financial performance. The organization serves as a valued partner to hospitals, health systems, and medical practices across the United States.

How to Apply

To apply, complete your application directly on this page, or you'll be redirected to the employer's application platform to finish submitting there.