Remote Senior Inpatient Auditor – MS-DRG & Clinical Validation

Position Description:

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.

Your future duties and 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.

Required qualifications to be successful in this role:

Education & Certifications:

Active AHIMA Credentials: RHIA, RHIT, or CCS required.

Certification Preference: CCS (Certified Coding Specialist) is highly preferred.

Experience & Skills:

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.

Personal Attributes:

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.

Preferred Qualifications:

Previous experience training or mentoring junior-level coders.

Willingness to travel occasionally for on-site reviews or specialized training.

Why CGI?

CGI’s Healthcare Compliance team offers a structured, well-defined training process and a robust quality management program. You will report to a Team Leader dedicated to your professional growth, ensuring you have the support and feedback needed to excel in a remote setting.



Other Information:

CGI is required by law in some jurisdictions to include a reasonable estimate of the compensation range for this role. The determination of this range includes various factors not limited to skill set, level, experience, relevant training, and licensure and certifications. To support the ability to reward for merit-based performance, CGI typically does not hire individuals at or near the top of the range for their role. Compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range for this role in the U.S. is $58,.00 - $,.00.

CGI's benefits are offered to eligible professionals on their first day of employment to include:
. Competitive compensation
. Comprehensive insurance options
. Matching contributions through the (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

Skills:

• Auditing (Claims)