DRG Inpatient Coding Validator

Responsibilities:

• Partner with Clinical, Claims, and Payment Integrity peers to review claims for DRG related issues on a prospective and retrospective basis.
• Proactively identify overpayments to ensure accurate claims payments on inpatient services.
• Participate in collaborative discussions with MDs to verify clinical rationale behind billed procedures.

Qualifications:

• Hold a CCS or CIC certification; required.
• Knowledge of DRG pricing methodology; required.
• At least 1 year of direct inpatient clinical coding experience.

Success Metrics:

• Within 90 days: demonstrate strong understanding of clinical coding practices and medical records review.
• By 6 months: work autonomously in clinical review workflows and develop strong interpersonal relationships.
• Continued success: deep understanding of workflows supporting clinical review lifecycle and regulatory compliance.

Benefits:

• Financial Well-Being: competitive salary, equity, performance bonus, 401k matching.
• Physical Well-Being: comprehensive medical, dental, and vision coverage.
• Mental Well-Being: No-Meeting Fridays, monthly holidays, mental health resources, flexible time-off, remote-first culture.
• Professional Development: learning programs, mentorship, funding, performance feedback.
• Additional Perks: ESPP, office setup reimbursement, cell/internet stipend, paid parental leave.