State Licensed DRG Validator

Job Summary

To support a growing Revenue Integrity Optimization team, the remote State Licensed DRG Validator will perform comprehensive inpatient coding and clinical validation reviews, focusing on MS-DRG and APR-DRG methodologies while ensuring coding accuracy, compliance, and quality.

Key responsibilities

• Conduct comprehensive inpatient coding and clinical validation reviews across MS-DRG and APR-DRG methodologies
• Ensure compliance and accuracy in coding by focusing on broader clinical quality considerations, including HACs and PSIs
• Meet established productivity, quality, and performance expectations in a high-performing team environment

Required qualifications

• At least one of the following credentials: CCS, RHIT, RHIA, or CIC
• Minimum 5 years of inpatient coding, CDI, DRG validation, or revenue integrity experience, with at least 3 years as a DRG validator
• Advanced knowledge of ICD-10-CM and ICD-10-PCS coding systems
• Strong understanding of MS-DRG and APR-DRG methodologies
• Demonstrated strong computer literacy and ability to navigate EMR systems and coding software efficiently