Job Description
Are you an experienced Inpatient DRG Auditor who thrives on complex clinical validation and payer logic?
LexiCode is expanding our elite remote audit team supporting national healthcare clients with high-level MS-DRG and APR-DRG validation services. This is a true audit role — not production coding — designed for experts who enjoy analytical review, documentation defense, and detailed rebuttal writing. As a DRG Auditor at LexiCode, you will join a dynamic team of consulting experts dedicated to delivering exceptional audit services to our valued clients.
Pay Disclosure:
LexiCode is required by state specific laws to include the salary range for this role when hiring a resident in applicable locations. The pay range for this position starts at $80,000 per year; however, base pay offered may vary depending on job-related knowledge, skills, and experience. Bonus opportunities may be provided as part of the compensation package, in addition to a full range
Essential Functions and Responsibilities
Performs analysis of medical records and provider claims to validate appropriate DRG and ICD-10-CM/PCS code assignment, including complex medical and surgical cases
Ensures that assigned codes and DRGs are supported by clinical documentation utilizing payer-specific clinical criteria
Applies Official Guidelines for Coding and Reporting consistently and appropriately
Provides detailed written explanations to support or rebut coding/DRG recommendations
Qualifications
- Required:
- RHIA, RHIT, or CCS credential from AHIMA or CPC combined with RHIA, RHIT or CCS
- 3 or more years of Inpatient/DRG auditing experience in an acute care setting or payer setting
- Expertise in ICD-10-CM/PCS, IPPS/MS-DRG and APR-DRG methodology and logic
- Excellent knowledge of ICD-10-CM/PCS Official Guidelines for Coding and Reporting, AHA Coding Clinics to support audit findings
- Proficiency in identifying clinical indicators to support documented diagnoses
- Outstanding computer skills and ability to work in multiple client-specific healthcare systems
- Excellent written communication and critical thinking skills
- Ability to efficiently review large volumes of documents with high comprehension level
- Secure home office environment, compliant with HIPAA and LexiCode’s security requirements
- Preferred:
- Experience in a payer coding/clinical DRG audit setting
- Prior experience/roles which may qualify:
- Inpatient Coding Auditor
- Inpatient Audit Specialist
- Inpatient Coding Quality Auditor
- IP Coding Compliance Auditor
- Inpatient Coding Consultant
- Facility Coding Auditor (Inpatient)
- Inpatient DRG Validation Auditor
- DRG Revenue Integrity Auditor
- MS-DRG Auditor
- DRG Review Specialist
- DRG Compliance Auditor
- Clinical DRG Auditor
- DRG Audit Consultant
- Payer DRG Auditor
- DRG Reimbursement Auditor
#1priority
Pay: From $80,000.00 per year
- Benefits:
- 401(k)
- Dental insurance
- Employee assistance program
- Employee discount
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Referral program
- Vision insurance
- Experience:
- Inpatient/DRG auditing experience in acute care or payer: 3 years (Required)
- ICD-10-CM/PCS, IPPS/MS-DRG: 3 years (Required)
- APR-DRG methodology and logic: 3 years (Required)
- ICD-10-CM/PCS Official Guidelines for Coding and Reporting: 3 years (Required)
- AHA Coding Clinics to support audit findings: 3 years (Required)
- License/Certification:
- RHIA, RHIT, or CCS credential from AHIMA (Required)
Work Location: Remote
Apply Now
Apply Now