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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in DRG validation audits, ensuring accurate coding and compliance with guidelines. Proficient in training and coaching staff while maintaining high standards of data quality and reimbursement.
Highest-signal resume keywords
CCS CertificationCIC CertificationAuditing Experience on IP DRGKnowledge of IPPS MethodologyGood Communication
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
DRG Validation AuditsCoding AccuracyDiscrepancy IdentificationAudit Trend MonitoringClinical Documentation ReviewData Quality AssuranceTraining DevelopmentReport PreparationSOP AdherenceQuality Target Achievement
Soft Skills
FlexibilityCoaching AbilityCollaborationFeedback ProvisionProblem-Solving
Tools & Technologies
Microsoft OutlookMicrosoft ExcelMicrosoft Word3M SoftwareNLP Tools
Certifications & Qualifications
CCSCIC
Industry Keywords
HIPAA ComplianceOIG ComplianceClinical Documentation ImprovementInpatient CodingAudit Findings
About the role
Key responsibilities & impact- Conduct detailed DRG validation audits on selected inpatient medical records
- Review documentation and confirm diagnoses and procedures are coded accurately and to the highest specificity
- Validate discharge disposition, Present on Admission indicators, and diagnosis sequencing
- Identify and correct discrepancies between coded data and clinical documentation
- Perform secondary reviews of complex or disputed coding cases
- Ensure adherence to coding guidelines, facility policies, and payer-specific rules
- Monitor audit trends and identify coding or documentation issues affecting data quality and reimbursement
- Collaborate with Compliance on audit findings and regulatory adherence
- Coach and provide feedback to coders and Clinical Documentation Improvement Specialists
- Develop and deliver training on DRG optimization, clinical indicators, coding guidelines, and audit findings
- Maintain audit records and prepare periodic reports with trends, root causes, and recommendations
- Communicate results to management and participate in performance improvement initiatives
- Collaborate with CDI teams, physicians, clinical staff, IT, and data analytics teams
- Follow SOPs and project protocols; complete audits with quality and meet quality and production targets
- Escalate issues, identify trends, and maintain productivity and clarification logs
- Respond promptly to manager emails and check with managers or team leads for clarifications
Requirements
What you’ll need- Mandatory CCS (Certified Coding Specialist) and CIC (Certified Inpatient Coder) certifications
- Auditing experience on IP DRG
- Knowledge of Microsoft Outlook, Excel, and Word
- Exposure to 3M software and NLP tools
- Bachelor's degree in Science; bachelor's degree in nursing preferable
- Knowledge of IPPS methodology
- Good Excel skills
- Flexibility
- Good communication
- Ability to follow SOPs and project-related protocols
- Ability to meet quality and production targets
- Ability to ensure HIPAA and OIG compliance