Remote Senior Inpatient Auditor – MS-DRG & Clinical Validation
About the position
CGI is seeking a high-caliber MS-DRG Auditor to join our Healthcare Compliance Team. In this role, you will be a key defender of payment accuracy, reviewing complex medical records to ensure that coding and reimbursements for Commercial and Government health plans are precise and well-supported. You will leverage your deep inpatient coding expertise and clinical intuition to identify improper payments while producing thoroughly documented decisions. At CGI, you aren't just an auditor; you are part of a structured professional ecosystem that prioritizes continuous learning, quality management, and career mentorship.
Responsibilities
• Clinical Record Validation: Review inpatient medical records to validate the assignment and sequencing of ICD-10 codes, discharge status, Hospital Acquired Conditions (HACs), POA assignment, and final DRG.
• Documentation Excellence: Author detailed rationale for every audit finding, producing "DRG Review Results" letters supported by authoritative coding references.
• Collaborative Review: Manage the referral process to Clinical Nurse Auditors or Physician Advisors when clinical complexity requires interdisciplinary input.
• Strategic Input: Partner with our Edit Development team to provide feedback on claim selection criteria and improve audit hit rates.
• Data Integrity: Verify client data, resolve discrepancies, and ensure all audit artifacts meet rigorous corporate and regulatory standards.
• Professionalism: Maintain high standards of productivity and audit quality while serving as a professional representative of CGI when interacting with providers.
Requirements
• Active AHIMA Credentials: RHIA, RHIT, or CCS required.
• Inpatient Expertise: Minimum of 5 years of inpatient coding experience.
• Deep Subject Matter Expertise: Extensive knowledge of ICD-10-CM/PCS coding and reimbursement methodologies, including MS-DRG and APR-DRG.
• Clinical & Analytical Rigor: Strong clinical validation skills combined with the ability to analyze data for trends in improper payments.
• Communication Mastery: Ability to write well-reasoned, narrative-style reviews with flawless grammar, punctuation, and sentence structure.
• Technical Proficiency: Advanced working knowledge of Microsoft Office (Excel, Word, Outlook) and Windows-based audit applications.
• Self-Directed: Proactive and capable of working independently in a remote environment.
• Adaptable: Resilience to shifting priorities and a commitment to meeting strict client deadlines.
• Growth Mindset: A passion for life-long learning and staying current with evolving coding guidelines.
Nice-to-haves
• Certification Preference: CCS (Certified Coding Specialist) is highly preferred.
• Previous experience training or mentoring junior-level coders.
• Willingness to travel occasionally for on-site reviews or specialized training.
Benefits
• Competitive compensation
• Comprehensive insurance options
• Matching contributions through the 401(k) plan and the share purchase plan
• Paid time off for vacation, holidays, and sick time
• Paid parental leave
• Learning opportunities and tuition assistance
• Wellness and Well-being programs
Apply tot his job
Apply To this Job
CGI is seeking a high-caliber MS-DRG Auditor to join our Healthcare Compliance Team. In this role, you will be a key defender of payment accuracy, reviewing complex medical records to ensure that coding and reimbursements for Commercial and Government health plans are precise and well-supported. You will leverage your deep inpatient coding expertise and clinical intuition to identify improper payments while producing thoroughly documented decisions. At CGI, you aren't just an auditor; you are part of a structured professional ecosystem that prioritizes continuous learning, quality management, and career mentorship.
Responsibilities
• Clinical Record Validation: Review inpatient medical records to validate the assignment and sequencing of ICD-10 codes, discharge status, Hospital Acquired Conditions (HACs), POA assignment, and final DRG.
• Documentation Excellence: Author detailed rationale for every audit finding, producing "DRG Review Results" letters supported by authoritative coding references.
• Collaborative Review: Manage the referral process to Clinical Nurse Auditors or Physician Advisors when clinical complexity requires interdisciplinary input.
• Strategic Input: Partner with our Edit Development team to provide feedback on claim selection criteria and improve audit hit rates.
• Data Integrity: Verify client data, resolve discrepancies, and ensure all audit artifacts meet rigorous corporate and regulatory standards.
• Professionalism: Maintain high standards of productivity and audit quality while serving as a professional representative of CGI when interacting with providers.
Requirements
• Active AHIMA Credentials: RHIA, RHIT, or CCS required.
• Inpatient Expertise: Minimum of 5 years of inpatient coding experience.
• Deep Subject Matter Expertise: Extensive knowledge of ICD-10-CM/PCS coding and reimbursement methodologies, including MS-DRG and APR-DRG.
• Clinical & Analytical Rigor: Strong clinical validation skills combined with the ability to analyze data for trends in improper payments.
• Communication Mastery: Ability to write well-reasoned, narrative-style reviews with flawless grammar, punctuation, and sentence structure.
• Technical Proficiency: Advanced working knowledge of Microsoft Office (Excel, Word, Outlook) and Windows-based audit applications.
• Self-Directed: Proactive and capable of working independently in a remote environment.
• Adaptable: Resilience to shifting priorities and a commitment to meeting strict client deadlines.
• Growth Mindset: A passion for life-long learning and staying current with evolving coding guidelines.
Nice-to-haves
• Certification Preference: CCS (Certified Coding Specialist) is highly preferred.
• Previous experience training or mentoring junior-level coders.
• Willingness to travel occasionally for on-site reviews or specialized training.
Benefits
• Competitive compensation
• Comprehensive insurance options
• Matching contributions through the 401(k) plan and the share purchase plan
• Paid time off for vacation, holidays, and sick time
• Paid parental leave
• Learning opportunities and tuition assistance
• Wellness and Well-being programs
Apply tot his job
Apply To this Job