Garden City, NY · Remote
$85K/yr
The DRG Validation position requires an extensive background in inpatient DRG coding with a deep understanding of the MS-DRG and APR-DRG payment systems. The validator is responsible for auditing ...
Garden City, NY · Remote
$85K/yr
The DRG Validation position requires an extensive background in inpatient DRG coding with a deep understanding of the MS-DRG and APR-DRG payment systems. The validator is responsible for auditing ...
Position Summary The DRG Validator/Reviewer is responsible for reviewing post-billed inpatient claims to identify and validate missed reimbursement opportunities based on diagnosis and procedure ...
Quick apply
Position Summary The DRG Validator/Reviewer is responsible for reviewing post-billed inpatient claims to identify and validate missed reimbursement opportunities based on diagnosis and procedure ...
OR · On-site +1
Position Summary The DRG Validator/Reviewer is responsible for reviewing post-billed inpatient claims to identify and validate missed reimbursement opportunities based on diagnosis and procedure ...
OR · On-site +1
Position Summary The DRG Validator/Reviewer is responsible for reviewing post-billed inpatient claims to identify and validate missed reimbursement opportunities based on diagnosis and procedure ...
Position Summary The DRG Validator/Reviewer is responsible for reviewing post-billed inpatient claims to identify and validate missed reimbursement opportunities based on diagnosis and procedure ...
Position Summary The DRG Validator/Reviewer is responsible for reviewing post-billed inpatient claims to identify and validate missed reimbursement opportunities based on diagnosis and procedure ...
Position Summary The DRG Validator/Reviewer is responsible for reviewing post-billed inpatient claims to identify and validate missed reimbursement opportunities based on diagnosis and procedure ...
Position Summary The DRG Validator/Reviewer is responsible for reviewing post-billed inpatient claims to identify and validate missed reimbursement opportunities based on diagnosis and procedure ...
Position Summary The DRG Validator/Reviewer is responsible for reviewing post-billed inpatient claims to identify and validate missed reimbursement opportunities based on diagnosis and procedure ...
Position Summary The DRG Validator/Reviewer is responsible for reviewing post-billed inpatient claims to identify and validate missed reimbursement opportunities based on diagnosis and procedure ...
Position Summary The DRG Validator/Reviewer is responsible for reviewing post-billed inpatient claims to identify and validate missed reimbursement opportunities based on diagnosis and procedure ...
Position Summary The DRG Validator/Reviewer is responsible for reviewing post-billed inpatient claims to identify and validate missed reimbursement opportunities based on diagnosis and procedure ...
Position Summary The DRG Validator/Reviewer is responsible for reviewing post-billed inpatient claims to identify and validate missed reimbursement opportunities based on diagnosis and procedure ...
Position Summary The DRG Validator/Reviewer is responsible for reviewing post-billed inpatient claims to identify and validate missed reimbursement opportunities based on diagnosis and procedure ...
White Plains, NY · On-site
$93K - $140K/yr
Coding Manager/DRG Validator White Plains, New York Health Information Management Day MON-FRI 9 AM-5 PM 75 Hours Per Pay Period $93,829.13 - $140,754.51 Job Summary The Coding Manager/DRG Validator ...
White Plains, NY · On-site
$93K - $140K/yr
Coding Manager/DRG Validator White Plains, New York Health Information Management Day MON-FRI 9 AM-5 PM 75 Hours Per Pay Period $93,829.13 - $140,754.51 Job Summary The Coding Manager/DRG Validator ...
White Plains, NY · On-site
$100 - $125/hr
The Manager/DRG validator is responsible for creating consistency and efficiency in inpatient claims processing and data collection to optimize DRG reimbursement and facilitate data quality in ...
White Plains, NY · On-site
$100 - $125/hr
The Manager/DRG validator is responsible for creating consistency and efficiency in inpatient claims processing and data collection to optimize DRG reimbursement and facilitate data quality in ...
Brunswick, GA · On-site +1
$31.25 - $42.25/hr
The DRG Validator ensures the accurate assignment of Diagnosis Related Groups (DRGs) for our patients and applies a thorough understanding of medical coding guidelines, clinical documentation, and ...
Brunswick, GA · On-site +1
$31.25 - $42.25/hr
The DRG Validator ensures the accurate assignment of Diagnosis Related Groups (DRGs) for our patients and applies a thorough understanding of medical coding guidelines, clinical documentation, and ...
Los Angeles, CA · On-site
$125 - $150/hr
Job Summary The Coding Manager/DRG Validator oversees the daily operations of the HIM Department inclusive of Inpatient Coding, with responsibility for all processes and procedures including ...
Los Angeles, CA · On-site
$125 - $150/hr
Job Summary The Coding Manager/DRG Validator oversees the daily operations of the HIM Department inclusive of Inpatient Coding, with responsibility for all processes and procedures including ...
Winslow, AZ · On-site
$93K - $140K/yr
The Manager/DRG validator is responsible for creating consistency and efficiency in inpatient claims processing and data collection to optimize DRG reimbursement and facilitate data quality in ...
Winslow, AZ · On-site
$93K - $140K/yr
The Manager/DRG validator is responsible for creating consistency and efficiency in inpatient claims processing and data collection to optimize DRG reimbursement and facilitate data quality in ...
Miami, FL · Remote
$74K - $96K/yr
The Clinical Documentation Integrity Specialist II - DRG Validator reviews selected inpatient accounts generally more than 48 hours from admission that have not been DRG optimized, using integrated ...
Miami, FL · Remote
$74K - $96K/yr
The Clinical Documentation Integrity Specialist II - DRG Validator reviews selected inpatient accounts generally more than 48 hours from admission that have not been DRG optimized, using integrated ...
Boca Raton, FL · Remote
$74K - $96K/yr
The Clinical Documentation Integrity Specialist II - DRG Validator reviews selected inpatient accounts generally more than 48 hours from admission that have not been DRG optimized, using integrated ...
Boca Raton, FL · Remote
$74K - $96K/yr
The Clinical Documentation Integrity Specialist II - DRG Validator reviews selected inpatient accounts generally more than 48 hours from admission that have not been DRG optimized, using integrated ...
Coral Gables, FL · Remote
$33 - $44.50/hr
The Clinical Documentation Integrity Specialist II - DRG Validator reviews selected inpatient accounts generally more than 48 hours from admission that have not been DRG optimized, using integrated ...
Coral Gables, FL · Remote
$33 - $44.50/hr
The Clinical Documentation Integrity Specialist II - DRG Validator reviews selected inpatient accounts generally more than 48 hours from admission that have not been DRG optimized, using integrated ...
Coral Gables, FL · On-site +1
$33 - $44.50/hr
The Clinical Documentation Integrity Specialist II - DRG Validator reviews selected inpatient accounts generally more than 48 hours from admission that have not been DRG optimized, using integrated ...
Coral Gables, FL · On-site +1
$33 - $44.50/hr
The Clinical Documentation Integrity Specialist II - DRG Validator reviews selected inpatient accounts generally more than 48 hours from admission that have not been DRG optimized, using integrated ...
Miami, FL · On-site +1
$74K - $96K/yr
The Clinical Documentation Integrity Specialist II - DRG Validator reviews selected inpatient accounts generally more than 48 hours from admission that have not been DRG optimized, using integrated ...
Miami, FL · On-site +1
$74K - $96K/yr
The Clinical Documentation Integrity Specialist II - DRG Validator reviews selected inpatient accounts generally more than 48 hours from admission that have not been DRG optimized, using integrated ...
Boca Raton, FL · On-site +1
$74K - $96K/yr
The Clinical Documentation Integrity Specialist II - DRG Validator reviews selected inpatient accounts generally more than 48 hours from admission that have not been DRG optimized, using integrated ...
Boca Raton, FL · On-site +1
$74K - $96K/yr
The Clinical Documentation Integrity Specialist II - DRG Validator reviews selected inpatient accounts generally more than 48 hours from admission that have not been DRG optimized, using integrated ...
San Antonio, TX · Remote
DRG Validation Auditors are charged with rendering appropriate, well-supported, and thoroughly-documented decisions, which may result in identification of improper payments (overpayments and ...
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San Antonio, TX · Remote
DRG Validation Auditors are charged with rendering appropriate, well-supported, and thoroughly-documented decisions, which may result in identification of improper payments (overpayments and ...
A DRG Validator reviews and validates Diagnosis-Related Group (DRG) codes assigned to patient records for accuracy and compliance with coding guidelines. They ensure that medical documentation supports the assigned codes, which directly impact hospital reimbursement and reporting. DRG Validators typically work in healthcare facilities, insurance companies, or auditing firms and must have expertise in medical coding, billing regulations, and clinical documentation.
As a DRG Validator, your typical day involves reviewing patient medical records and coding assignments to ensure accurate DRG classification and compliance with coding guidelines. You may collaborate closely with medical coders, clinical documentation improvement specialists, and healthcare providers to clarify documentation or resolve discrepancies. The role often requires you to stay updated on coding regulations and participate in quality assurance meetings. Attention to detail and thorough documentation are essential, as your work directly impacts hospital reimbursement and data integrity.
To thrive as a DRG Validator, you need a strong understanding of medical coding, clinical documentation, and Diagnosis Related Group (DRG) assignment, often supported by an RHIA, RHIT, or CCS certification. Familiarity with coding software (such as 3M or TruCode), electronic medical record (EMR) systems, and current ICD-10-CM/PCS coding standards is essential. Attention to detail, analytical thinking, and effective communication are key soft skills in this position. These abilities are crucial to accurately validate coding, ensure compliance with regulatory standards, and reduce reimbursement errors.
Cities with the most Drg Validator job openings:
The most popular types of Drg Validator jobs are:
States with the most job openings for Drg Validator jobs include:
For Drg Validator jobs, the most frequently searched job titles are:
Garden City, NY • Remote
$85K/yr
Full-time
Medical, Dental, Vision, Life, Retirement, PTO
Re-posted 9 days ago
The DRG Validation position requires an extensive background in inpatient DRG coding with a deep understanding of the MS-DRG and APR-DRG payment systems. The validator is responsible for auditing inpatient medical records, ensuring the accuracy of coding, provider documentation, and DRG assignment.
Key ResponsibilitiesPerform concurrent and retrospective clinically based and MS-DRG and APR DRG validation reviews in compliance with appropriate coding and payments adhering to Uniform
Hospital Discharge Date Set (UHDDS) and Medicare guidelines including Federal and State regulations.
Review the correct assignment of ICD-10-CM diagnosis & ICD-10-PCS procedure codes.
Effectively utilize facility Encoders, EMRs, abstracting systems (3M, EPIC, etc.) and auditing tools and systems (e.g., TruCode, 3M Standalone, etc.) proficiently to make audit determinations.
Write clear, accurate, and concise rationales supporting audit findings.
Compose physician queries for clarification of documentation.
Provide coder education referencing applicable coding references following audits.
Review DRG/coding denial letters and compose effectively supported appeal response letters to third party auditors and insurance carriers that summarize and support hospital position of upholding or overturning of External, PRO and/or RAC Determinations.
Provide written recommendations for optimal coding and DRG / SOI assignment.
Stay up to date on regulatory changes affecting coding rules and regulations.
Maintain proficiency on the Official Coding Guidelines for Coding and Reporting and AHA
Coding Clinics.
Meets or Exceeds Standards / Guidelines for productivity maintaining production goals set by the Director of HIM Technical Services.
Meets or Exceeds Standards / Guidelines for accuracy and quality achieving the expected level set by the Director of HIM Technical Services. Quality accuracy rate must be maintained at 95-100%.
Able to effectively communicate with physicians, CDI staff and other clinicians regarding documentation, queries and/or coding guidelines.
QualificationsMust have one of the following AHIMA certifications: CCS, RHIT, or RHIA
Extensive knowledge of medical terminology, anatomy, coding terminology and coding guidelines for ICD-10-CM/PCS, CPT, Modifiers, etc.
Equivalent experience of 5+ years in DRG/Clinical Validation claims auditing, quality assurance or recovery auditing.
Minimum of 5+ years of working with ICD-10-CM/PCS, MS-DRG, and APR-DRG with a broad knowledge of medical claims billing/payment systems, and payer reimbursement policies.
Adherence to Official Coding Guidelines for Coding and Reporting, Coding Clinic determinations, CMS, and other regulatory compliance guidelines and mandates which requires expert coding knowledge of DRG, ICD-10-CM and PCS codes.
Demonstrates basic skills in Microsoft Outlook, Word, Excel, PowerPoint, 3M, TruCode,Teams, SharePoint, and other applications.
Must have good written and verbal communication skills.
Possess the ability to educate health care professionals in various settings.
Responsible and self-sufficient with strong analytical and research skills.
Must be able to meet or exceed deadline completion times required.
Job Type: Full-time
Salary: From $80,000.00 per year
Benefits:401(k)
401(k) matching
Dental insurance
Flexible schedule
Health insurance
Life insurance
Paid time off
Vision insurance
Schedule:8 hour shift
Work setting:Remote
Experience: ICD coding: 5 years (Required)
License/Certification:AHIMA Certification (Required)
