DRG Validation Auditor

POSITION

• DRG Validation Auditor - Inpatient Medical Coder

WORK SET UP : Onsite

Location: Orttigas and Taguig

WORK SCHEDULE: Night Shifting Schedule

SALARY PACKAGE: 60, ,000

KINDLY INCLUDE YOUR JOB DESCRIPTION, DUTIES & RESPONSIBILITIES, TOOL, CERTIFICATION AND TRAINING IN YOUR CV FOR PAPER SCREENING

FUTURE DUTIES AND RESPONSIBILITIES

• Reviews inpatient medical records to validate, assignment and sequencing of ICD-10 diagnosis and procedure codes, discharge status codes, Hospital Acquired Conditions (HACs), POA assignment, and DRG assignment.
• Provides a detailed rationale for every medical record review resulting in a DRG Review Results letter, including supporting references.
• Follows proper procedure for referral to Clinical Nurse Auditor or Physician Advisor, as applicable.
• Utilizes proper reference material, standards, and guidelines for coding.
• Provides input to the Edit Development team on claims selection criteria.
• Verifies data received from client and work to resolve discrepancies.
• If the contract requires onsite review, interacts with Providers and other personnel in a professional manner.
• Follows company policies and processes, completing Red Carpet, timesheets, payroll, travel expense documents, and other corporate requirements in a timely manner.
• Communicates timely with Team Lead regarding illnesses, appointments, vacation requests, changes in work schedule, performance barriers, and computer issues.
• Complies with department standards regarding productivity and audit quality.
• Performs other duties as assigned.

REQUIRED QUALIFICATIONS

• Holds current AHIMA credentials (RHIT, RHIA, or CCS); CCS preferred
• Minimum of 2-3 years of inpatient coding experience
• Strong knowledge of ICD-10-CM/PCS coding and DRG reimbursement
• Experience in training and mentoring junior coders is highly desirable
• Proficient in MS-DRG and APR-DRG reimbursement methodologies
• Demonstrates strong clinical validation and data analysis skills
• Skilled in using Microsoft Office (Outlook, Word, Excel) and Windows OS
• Ability to write clear, well-structured narrative reviews with proper grammar and punctuation
• Able to adapt to shifting priorities and meet productivity standards and deadlines
• Self-directed, detail-oriented, and passionate about continuous learning
• May be required to travel occasionally for training or on-site reviews

Job Types: Full-time, Permanent

Pay: Php60, Php70,000.00 per month

Benefits:

• Company Christmas gift
• Company events
• Flexible schedule
• Health insurance
• Opportunities for promotion
• Paid training
• Pay raise
• Promotion to permanent employee

Education:

• Bachelor's (Preferred)

Experience:

• Inpatient Medical Coder: 5 years (Preferred)

License/Certification:

• AHIMA Certification (Preferred)

Work Location: Remote