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California Licensed DRG Audit SME
Key Responsibilities Conduct comprehensive DRG validation audits of inpatient medical records for accurate coding and compliance Serve as an inpatient coding expert and resource for coding teams, ensuring accuracy and adherence to standards DevelopClinical Auditor - State Licensed
Key Responsibilities Audit outpatient and specialty claims using medical chart coding principles and client-specific guidelines Utilize advanced coding expertise and audit tools to evaluate medical records and identify billing issues Recommend new...record coding or auditing Broad knowledge of medical claims billing/payment systems and coding terminology Expert knowledge of coding guidelines, including DRG, ICD-10, CPT, and HCPCS codes
