The DRG Validation Auditor is part of the DRG Validation Team and is responsible for reviewing medical records to ensure accurate coding and proper reimbursement for clinical services provided to members of Commercial and Government health plans. The auditor reviews paid claims and identifies possible overpayments or underpayments on behalf of the client. These claims may come from various healthcare providers, including acute care hospitals, long-term acute care, rehabilitation centers, skilled nursing facilities, and other care settings. Auditors receive thorough training to understand how to review medical records, apply correct coding guidelines, and use client-specific documentation formats. Ongoing education is also provided to keep up with changes in coding rules, audit processes, and reimbursement practices. The review process may lead to adjustments in payment for previously billed services. Auditors use their coding knowledge and critical thinking to evaluate documentation and make informed decisions.