Certified Coding Specialist (CCS)

Job Summary

To optimize hospital reimbursement, the full-time remote DRG Validator/Reviewer will review post-billed inpatient claims, validate missed reimbursement opportunities, and analyze medical records using ICD-10 coding expertise.

Key Responsibilities

• Review inpatient claims in the DRG database for diagnosis, procedures, and reimbursement accuracy
• Analyze hospital billing files to identify underpaid claims based on ICD-10 codes
• Conduct detailed medical record reviews to ensure accuracy and completeness of submitted codes

Required Qualifications

• Associate's or bachelor's degree in health information management or related field required
• Certified Coding Specialist (CCS) certification required
• 2-3 years' experience in DRG validation or inpatient medical coding
• Strong understanding of ICD-10-CM/PCS coding guidelines and DRG reimbursement methodology
• Experience in a post-bill coding environment with familiarity in DRG grouping software