DRG Validator- Remote

Posted 2 days ago

jzanus consultingDenver (CO)

Health Information Technologists and Medical Registrars General Medical and Surgical Hospitals

SENIORITY

Senior

SALARY

$80,000 per year

Apply

About the role

Job description: The DRG Validation position requires an extensive background in inpatient DRG coding with a deep understanding of the MS-DRG and APR-DRG payment systems. The validator is responsible for auditing inpatient medical records, ensuring the accuracy of coding, provider documentation, and DRG assignment.

Key Responsibilities:

Perform concurrent and retrospective clinically based and MS-DRG and APR DRG validation reviews in compliance with appropriate coding and payments adhering to Uniform
Hospital Discharge Date Set (UHDDS) and Medicare guidelines including Federal and State regulations.
Review the correct assignment of ICD-10-CM diagnosis & ICD-10-PCS procedure codes.
Effectively utilize facility Encoders, EMRs, abstracting systems (3M, EPIC, etc.) and auditing tools and systems (e.g., TruCode, 3M Standalone, etc.) proficiently to make audit determinations.
Write clear, accurate, and concise rationales supporting audit findings.
Compose physician queries for clarification of documentation.
Provide coder education referencing applicable coding references following audits.
Review DRG/coding denial letters and compose effectively supported appeal response letters to third party auditors and insurance carriers that summarize and support hospital position of upholding or overturning of External, PRO and/or RAC Determinations.
Provide written recommendations for optimal coding and DRG / SOI assignment.
Stay up to date on regulatory changes affecting coding rules and regulations.
Maintain proficiency on the Official Coding Guidelines for Coding and Reporting and AHACoding Clinics.
Meets or Exceeds Standards / Guidelines for productivity maintaining production goals set by the Director of HIM Technical Services.

Meets or Exceeds Standards / Guidelines for accuracy and quality achieving the expected level set by the Director of HIM Technical Services. Quality accuracy rate must be maintained at 95-100%.Able to effectively communicate with physicians, CDI staff and other clinicians regarding documentation, queries and/or coding guidelines.

Qualifications: Must have one of the following AHIMA certifications: CCS, RHIT, or RHIAExtensive knowledge of medical terminology, anatomy, coding terminology and coding guidelines for ICD-10-CM/PCS, CPT, Modifiers, etc. Equivalent experience of 5+ years in DRG/Clinical Validation claims auditing, quality assurance or recovery auditing. Minimum of 5+ years of working with ICD-10-CM/PCS, MS-DRG, and APR-DRG with a broad knowledge of medical claims billing/payment systems, and payer reimbursement policies. Adherence to Official Coding Guidelines for Coding and Reporting, Coding Clinic determinations, CMS, and other regulatory compliance guidelines and mandates which requires expert coding knowledge of DRG, ICD-10-CM and PCS codes. Demonstrates basic skills in Microsoft Outlook, Word, Excel, PowerPoint, 3M, TruCode, Teams, SharePoint, and other applications. Must have good written and verbal communication skills. Possess the ability to educate health care professionals in various settings. Responsible and self-sufficient with strong analytical and research skills. Must be able to meet or exceed deadline completion times required.

Job Type: Full-time

Salary: From $80,000.00 per year

Benefits:

401(k)401(k) matching
Dental insurance
Flexible schedule
Health insurance
Life insurance
Paid time off
Vision insurance

Schedule: 8 hour shift

Work setting: Remote

Experience: ICD coding: 5 years (Required)

License/Certification: AHIMA Certification (Required)

Before you apply

Applying takes about a minute. These four things decide how fast it moves after that.

Your profile is current

It's what we read first. Occupations, seniority and locations matter more than a long history.

Two examples you can talk through

Not a portfolio — just two pieces of work where you can explain the decisions and what you'd change.

A number in mind

What you're on now and what would make you move. We negotiate better when we know both.

Your notice period

Employers plan around it, and it's the question that stalls offers most often.

Once you apply, someone reads it and calls you before anything reaches the employer — usually within two working days.