Senior DRG Clinical Auditor

A company is looking for a Senior DRG Clinical Auditor to analyze complex healthcare claims for accurate billing and compliance. Key Responsibilities Review and analyze complex inpatient and outpatient charges across various revenue centers Perform detailed itemized bill reviews to identify billing irregularities and apply national coding standards Document audit results and ensure compliance with HIPAA regulations and reimbursement policies Required Qualifications High school diploma and 5+ years of DRG bill review experience, or completion of a medical license or coding certification Extensive knowledge of inpatient and outpatient hospital billing, including UB-04 forms and coding systems Strong working knowledge of DRG reimbursement methodology Familiarity with payer reimbursement policies and regulatory standards Experience reviewing medical records and claim documentation