RN Inpatient DRG Validation Specialist

Job Summary

To support a growing healthcare technology organization, the remote RN Inpatient DRG Validation Specialist will review inpatient claims and medical records to ensure accurate DRG assignments, leveraging clinical expertise and judgment to enhance payment integrity processes.

Key responsibilities:

• Review inpatient claims and medical records to validate diagnoses and procedures for DRG assignments
• Evaluate clinical documentation and identify discrepancies affecting payment accuracy and DRG assignment
• Collaborate with operational and technology teams to improve audit processes and clinical review methodologies

Required qualifications:

• Active Registered Nurse (RN) license
• 3+ years of experience in inpatient DRG validation or clinical claims auditing
• Hands-on experience with clinical DRG validation and inpatient audits
• Strong knowledge of ICD-10-CM and ICD-10-PCS concepts and inpatient reimbursement practices
• Experience in healthcare audit, consulting, or Payment Integrity environments preferred