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4 ZignaAI Jobs
DRG Auditing Specialist
ZignaAI
posted 4mon ago
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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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