Certified DRG Claims Auditor
Company: VirtualVocations
Location: Vista
Posted on: May 20, 2025
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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, Mission Viejo , Certified DRG Claims Auditor, Accounting, Auditing , Vista, California
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