DRG Validator/Reviewer

The DRG Validator/Reviewer is responsible for reviewing post-billed inpatient claims imported into the DRG database, focusing on diagnosis, procedures, grouping logic, and reimbursement accuracy. Responsibilities include analyzing weekly hospital billing files, conducting detailed medical record reviews post-bill to ensure accuracy and completeness of submitted diagnosis and procedure codes. The role involves navigating medical records, matching clinical documentation to ICD-10 codes, identifying and correcting errors, making reimbursement improvement recommendations, and collaborating with leadership on case prioritization and workflow management. Staying informed on coding updates, payer guidelines, and DRG changes is essential. Requirements include an associate's or bachelor’s degree in health information management, CCS certification, and 2-3 years’ experience in DRG validation, inpatient medical coding, or related coding review. Strong analytical, problem-solving, and communication skills are a must, along with comfort navigating multiple digital platforms and EMRs.