State Licensed DRG Validator

Job Summary

Seeking a remote, full-time State Licensed DRG Validator, this position will conduct inpatient coding and DRG validation reviews, ensuring accuracy in coding and compliance with regulations while utilizing various health information management systems.

Key responsibilities

• Conduct concurrent and retrospective reviews of inpatient medical records to validate coding accuracy and DRG assignment
• Evaluate ICD-10-CM and ICD-10-PCS codes, MS-DRG and APR-DRG classifications, and ensure compliance with relevant guidelines
• Prepare audit findings, develop physician documentation queries, and provide education to coding professionals on coding guidelines and documentation requirements

Required qualifications

• AHIMA credential such as Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA)
• Minimum 5 years of inpatient coding experience with ICD-10-CM/PCS
• Minimum 5 years of experience in DRG validation, clinical validation, or related auditing roles
• Advanced knowledge of ICD-10 coding, MS-DRG and APR-DRG methodologies, and clinical documentation improvement
• Proficiency with coding and auditing software, including 3M, TruCode, and Epic