Remote Clinical QC Auditor (DRG Auditor)

DRG Quality Control Clinical Auditor Remote (United States) Industry: Healthcare | Clinical Audit | Revenue Integrity Employment Type: Full-Time Company Overview TalentLNX is partnering with a confidential healthcare organization seeking an experienced Clinical Auditor to support inpatient DRG validation and quality review initiatives. This organization works across complex medical record audits to ensure documentation accuracy, reimbursement integrity, and compliance with regulatory standards. Position Summary The DRG Quality Control Clinical Auditor is responsible for conducting detailed reviews of inpatient medical records to validate coding accuracy and appropriate DRG assignment. This role applies clinical knowledge, coding guidelines, and payer regulations to determine whether documentation supports the assigned reimbursement structure. The ideal candidate combines strong inpatient clinical experience with advanced coding knowledge and the ability to clearly document findings in a defensible, professional manner. This is a remote position requiring independent work and collaboration with quality and leadership teams. Essential Responsibilities • Perform comprehensive reviews of inpatient medical records for DRG validation • Evaluate coding accuracy using ICD-10-CM and PCS guidelines • Confirm documentation supports assigned DRGs and reimbursement methodology • Identify discrepancies and document findings with appropriate clinical rationale • Apply Medicare, Medicaid, and payer-specific regulatory standards during review • Conduct quality checks on prior audit work when required • Support appeals and rebuttal processes as needed • Maintain compliance with HIPAA and internal audit policies • Communicate findings clearly and escalate trends or concerns to leadership Knowledge & Skills • Strong knowledge of Official Coding Guidelines and clinical documentation standards • Experience applying CMS and payer rules in audit determinations • Familiarity with MS-DRG and APR-DRG methodologies preferred • High attention to detail and strong analytical skills • Clear and professional written communication • Ability to work independently in a remote setting • Strong organizational and time management skills • Proficiency with Microsoft Office and standard audit platforms Education & Experience • Active LVN or RN license preferred • Inpatient clinical background strongly preferred • Minimum 2 years of recent DRG quality auditing experience required • National coding certification required (AHIMA preferred; AAPC accepted) • Hands-on ICD-10-CM and ICD-10-PCS experience required Compensation Salary Range: $70,000 – $100,000 annually Compensation is based on experience, qualifications, geographic considerations, and internal equity. Final placement within the range will be determined during the interview process. Schedule • Remote position • Standard business hours • Independent workflow with collaborative quality review structure Interview Process • TalentLNX introductory screening • Client leadership interview • Final review and offer discussion Process steps may vary. Equal Opportunity Statement TalentLNX and our client partners are Equal Opportunity Employers. Qualified applicants will be considered without regard to legally protected characteristics. Pay: $70,000.00 - $100,000.00 per year Benefits: • 401(k) • 401(k) matching • Flexible schedule • Flexible spending account • Health insurance • Health savings account • Life insurance • Paid time off • Parental leave • Professional development assistance • Tuition reimbursement • Vision insurance Application Question(s): • Do you have hands-on experience performing DRG validation audits on inpatient medical records? Experience: • Medical documentation: 1 year (Preferred) • DRG: 1 year (Preferred) License/Certification: • RN License (Preferred) Location: • Remote (Preferred) Work Location: Remote Apply tot his job Apply To this Job