DRG Validator

Responsibilities:

• Analyze and audit claims integrating medical chart coding principles, clinical guidelines, and objective medical audit activities.
• Exhibit advanced ICD-10 coding expertise and industry knowledge to support audit conclusions.
• Utilize audit tools and workflow systems to determine findings and recommend changes, deletions, or modifications of DRGs.
• Maintain accuracy and quality standards for audits and ensure documentation consistency.
• Identify potential claims for additional recoveries such as re-admissions, DRG optimization, and HACs.
• Manage priorities to ensure timely completion of inpatient coding reviews.
• Suggest and recommend process improvements and efficiency enhancements.

Required Qualifications:

• Held RHIA, RHIT, CCS, or CIC certification for at least 3 years.
• Over 3 years of inpatient coding review and auditing experience within hospital settings.
• Professional experience with APR-DRG coding and auditing.
• Ability to work independently with limited supervision.
• Excellent written and verbal communication skills for generating DRG audit rationales.
• General knowledge of Microsoft Office (Word, PowerPoint, Access, Excel).

Preferred Qualifications:

• Associate degree or higher in Health Information Management (HIT).
• Experience with 3M encoder software.
• Experience with cost outlier and recovery identification specialized audits.