DRG Validator/Reviewer - Remote

Overview

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.

In Short

• Review inpatient claims for diagnosis, procedures, and reimbursement accuracy.
• Analyze hospital billing files to identify underpaid claims.
• Conduct medical record reviews to ensure coding accuracy.
• Match clinical documentation to ICD-10 codes.
• Identify and correct coding errors.
• Utilize Health ROI system edits for high-value opportunities.
• Make reimbursement improvement recommendations.
• Collaborate with leadership on workflow management.
• Stay informed on coding updates and payer guidelines.
• Analyze client reporting and identify new revenue opportunities.

Requirements

• Associate's or bachelor’s degree in health information management or related field required.
• Certified Coding Specialist (CCS) certification required.
• 2-3 years’ experience in DRG validation or coding review.
• Strong understanding of ICD-10-CM/PCS coding guidelines.
• Proficient in interpreting clinical documentation.
• Experience in a post-bill coding environment.
• Analytical thinker focused on reimbursement accuracy.
• Strong computer proficiency and MS Office skills.
• Ability to perform essential duties satisfactorily.
• Excellent communication and documentation skills.

Benefits

• Flexible remote work options.
• Opportunities for professional development.
• Supportive team environment.
• Recognition as a top workplace.
• Competitive salary and benefits package.