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ZignaAI

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4.8

based on 4 Reviews

2 ZignaAI Jobs

DRG Auditing Specialist

ZignaAI

4.8

based on 4 Reviews

2-3 years

Hyderabad / Secunderabad

1 vacancy

DRG Auditing Specialist

ZignaAI

posted 1mon ago

Job Role Insights

Key skills for the job

Medical Coding Data Analysis Costing Healthcare Machine Learning Auditing

+ 3 more

Job Description

Our organization is seeking a detail-oriented DRG Auditing Specialist. This role focuses on analyzing health data, performing DRG audit quality reviews. The ideal candidate will hold a coding credential from AHIMA or AAPC, have completed coursework in medical terminology, anatomy, and physiology, and have relevant experience in DRG with a deep understanding of coding guidelines, payor guidelines, and contracts.

Responsibilities:

Perform comprehensive audits using ICD-10-CM, ICD-10-PCS, CPT, and HCPCS codes.
Ensure compliance with healthcare regulations and maintain awareness of industry changes.
Generate and present detailed reports on audit findings and recommendations for improved DRG auditing.
Support in researching and documenting inpatient audits to enable reimbursement accuracy.
Possess the ability to work with a cross-functional team and communicate the DRG audit results clearly.
Other duties as assigned as needed by your leadership to support the program.

Qualifications:

Active coding credential from AHIMA or AAPC (RHIA, RHIT, CCS, CCS-P, CIC, COC, CPC). A degree in a healthcare-related field is a plus.
Minimum of 2-3 years of experience conducting DRG and/or APC audits.
In-depth knowledge of coding guidelines, payor guidelines, and contracts.
Proven ability in managing time and prioritizing work effectively.
Excellent written and verbal communication skills.
In-office position on mid-shift.
Experience with AI programming, particularly in machine learning and deep learning models, is a plus.

Employment Type: Full Time, Permanent

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