EnableComp provides specialty revenue cycle management solutions for healthcare organizations, helping hospitals, health systems, and ambulatory surgery centers improve financial sustainability.
The DRG Validator/Reviewer is responsible for reviewing post-billed inpatient claims to identify and validate missed reimbursement opportunities based on diagnosis and procedure coding. Working within a specialized DRG database, this role uses ICD-10 coding expertise to analyze medical records, determine coding accuracy, and make recommendations that optimize hospital reimbursement. The position handles PHI and requires strict privacy, security, and professionalism.
- Associate's or bachelor's degree in health information management or a related field required; RHIT or RHIA credential preferred.
- Certified Coding Specialist (CCS) certification required.
- 2-3 years of experience in DRG validation, inpatient medical coding, or related coding review.
- Strong understanding of ICD-10-CM/PCS coding guidelines, DRG reimbursement methodology, and hospital billing processes.
- Ability to read and interpret clinical documentation across multiple departments, including nursing, operative, radiology, and pharmacy.
- Experience in a post-bill coding environment and familiarity with DRG grouping software and billing databases.
- Strong analytical, problem-solving, and financial impact assessment skills.
- Proficiency with EMRs, digital platforms, and basic office software such as Word, Excel, and Outlook.
- Excellent communication, documentation, and customer service skills.
- Ability to work independently, manage multiple priorities, and handle high volumes of medical and billing data.
Location
Tennessee, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
Yes
Posted
4 weeks ago