Certified DRG Claims Auditor

Company: VirtualVocations
Location: Vista
Posted on: May 20, 2025

Job Description:

A company is looking for a DRG Claims Auditor, Recoveries.
Key Responsibilities

Perform DRG validation and quality audits on claims, focusing on overpayment identification
Utilize clinical knowledge to ensure accurate ICD-10-CM/PCS code assignments and compliance with guidelines
Review and analyze claims to support medical policies and identify billing trends for potential recoveries

Required Qualifications

Associate's degree required; Bachelor's degree preferred
Certification as a Certified Inpatient Coder (CIC), Certified Professional Coder (CPC), or similar
5+ years of experience in DRG validation or claims auditing
Thorough knowledge of ICD-10, CPT, HCPCS, and Revenue Billing Codes
Nursing license preferred

Keywords: VirtualVocations, Temecula , Certified DRG Claims Auditor, Accounting, Auditing , Vista, California

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