Remote Senior Inpatient Auditor – MS-DRG & Clinical Validation

Position Description:

CGI is seeking a high-caliber MS-DRG Auditor to join our Healthcare Compliance 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 arent 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

CGIs 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 $58000.00 - $114900.00.

CGIs benefits are offered to eligible professionals on their first day of employment to include:
. 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

Skills:

• Auditing (Claims)

What you can expect from us:

Together as owners lets turn meaningful insights into action.

Life at CGI is rooted in ownership teamwork respect and belonging. Here youll reach your full potential because

You are invited to be an owner from day 1 as we work together to bring our Dream to life. Thats why we call ourselves CGI Partners rather than employees. We benefit from our collective success and actively shape our companys strategy and direction.

Your work creates value. Youll develop innovative solutions and build relationships with teammates and clients while accessing global capabilities to scale your ideas embrace new opportunities and benefit from expansive industry and technology expertise.

Youll shape your career by joining a company built to grow and last. Youll be supported by leaders who care about your health and well-being and provide you with opportunities to deepen your skills and broaden your horizons.

Come join our teamone of the largest IT and business consulting services firms in the world.

Qualified applicants will receive consideration for employment without regard to their race ethnicity ancestry color sex religion creed age national origin citizenship status disability pregnancy medical condition military and veteran status marital status sexual orientation or perceived sexual orientation gender gender identity and gender expression familial status or responsibilities reproductive health decisions political affiliation genetic information height weight or any other legally protected status or characteristics to the extent required by applicable federal state and/or local laws where we do business.

CGI provides reasonable accommodations to qualified individuals with disabilities. If you need an accommodation to apply for a job in the U.S. please email the CGI U.S. Employment Compliance mailbox at . You will need to reference the Position ID of the position in which you are interested. Your message will be routed to the appropriate recruiter who will assist you. Please note this email address is only to be used for those individuals who need an accommodation to apply for a job. Emails for any other reason or those that do not include a Position ID will not be returned.

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All CGI offers of employment in the U.S. are contingent upon the ability to successfully complete a background investigation. Background investigation components can vary dependent upon specific assignment and/or level of US government security clearance held. Dependent upon role and/or federal government security clearance requirements and in accordance with applicable laws some background investigations may include a credit check. CGI will consider for employment qualified applicants with arrests and conviction records in accordance with all local regulations and ordinances.

CGI will not discharge or in any other manner discriminate against employees or applicants because they have inquired about discussed or disclosed their own pay or the pay of another employee or applicant. However employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information unless the disclosure is (a) in response to a formal complaint or charge (b) in furtherance of an investigation proceeding hearing or action including an investigation conducted by the employer or (c) consistent with CGIs legal duty to furnish information.