DRG Coder / Clinical Auditor
Pivotal Placement Services
Niceville, FL
DRG Coder / Clinical Auditor
Remote | Full-Time | Healthcare | Clinical Documentation & Coding
About the Role
We’re seeking a detail-oriented DRG Coder/Clinical Auditor to perform DRG validation reviews of medical records and documentation. This role ensures accurate coding and clinical support for DRG assignments, helping improve billing accuracy, reimbursement, and compliance. You’ll work independently to review records, validate coding, and communicate findings clearly and professionally.
Key Responsibilities
Chart Review & Validation
Review medical records to validate DRG assignments and ensure clinical documentation supports coding decisions.Physician Documentation Review
Confirm that physician notes and clinical indicators support assigned DRGs.Audit & Compliance
Conduct audits to verify coding accuracy, enhance reimbursement, and identify cost-saving opportunities.Coding Expertise
Apply ICD-10-CM and PCS coding guidelines, payer rules, and regulatory standards (Medicare, Medicaid, CMS).Communication & Reporting
Clearly document findings and communicate results in a professional and concise manner.Other Duties
Support additional documentation and coding-related tasks as assigned.
Qualifications
- Licensure: RN or LPN/LVN license required — or RHIT credential for non-nurses.
- Experience:
- Minimum 1 year of recent DRG auditing experience in a hospital or health plan setting.
- Inpatient ICD-10 coding experience required.
- CDI candidates are encouraged to apply.
- Certifications:
- National coding certification through AHIMA (preferred) or AAPC.
- CCS or CIC strongly preferred.
- Technical Skills:
- Proficient in MS and APR DRG methodology.
- Familiarity with Coding Clinic citations and Official Coding Guidelines.
- Strong understanding of Medicare/CMS documentation requirements.
- Soft Skills:
- Exceptional attention to detail.
- Strong problem-solving and critical thinking abilities.
- Effective verbal and written communication.
- Ability to work independently in a fast-paced, production-driven environment.
- Tools:
- Proficient in Microsoft Office Suite.
Compensation
Pay Range: $90,000 – $104,841
Salary is based on location, experience, qualifications, and internal equity. Final compensation may vary depending on assessment during the interview process.
Who We Are
Headquartered in Central Florida, Pivotal Placement Services is a full-service national workforce solutions firm that specializes in placing healthcare professionals—from staff to leadership—with both clinical and non-clinical employers. Our comprehensive and customer-focused workforce solutions include Direct Placement and Managed Service Provider (MSP) / Vendor Managed Services (VMS) engagements nationwide.