DRG Validator

Role overview Review inpatient records to assess coding accuracy, clinical support, compliance, and reimbursement under both MS-DRG and APR-DRG methodologies. The work also considers quality measures such as hospital-acquired conditions, patient safety indicators, and Elixhauser measures, with established expectations for review volume and accuracy.

Responsibilities - Perform inpatient coding and clinical validation reviews across MS-DRG and APR-DRG cases. - Assess documentation and code assignment for accuracy, compliance, and reimbursement integrity. - Consider relevant quality indicators, including HACs, PSIs, and Elixhauser measures. - Navigate electronic medical records, DRG grouping software, and other review platforms efficiently. - Meet defined productivity and quality standards while collaborating with a U.S.-based team.

Requirements - Hold at least one credential: CCS, RHIT, RHIA, or CIC. - Have at least five years of experience in inpatient coding, CDI, DRG validation, or revenue integrity, including three years as a DRG validator. - Demonstrate advanced knowledge of ICD-10-CM and ICD-10-PCS and a strong grasp of MS-DRG and APR-DRG methods. - Bring strong analytical, written, and verbal communication skills. - Be comfortable with EMR systems, DRG grouping tools, Microsoft applications, and related technology. - Be legally authorized to work in the United States; visa sponsorship is unavailable.

Nice to have - CDIP or CDIS certification, payer reimbursement knowledge, or experience with quality indicators and risk adjustment. - Consulting or client-facing experience, and familiarity with compliant physician queries and clinical validation.

Benefits and work setup The team offers continuing education support and reimbursement for eligible credential renewals. The listing also describes a collaborative environment and opportunities to broaden expertise and pursue career growth.