DRG Validator/Reviewer

This is a fully remote position, open to applicants in Tennessee.

📋 Description

• Evaluate inpatient claims that are imported into the DRG database, with a focus on diagnosis, procedures, grouping logic, and accuracy of reimbursement.

• Review weekly hospital billing files to identify claims that are underpaid based on ICD-10 diagnosis and procedure codes.

• Perform comprehensive medical record assessments after billing to confirm the accuracy and completeness of the submitted diagnosis and procedure codes.

• Efficiently navigate medical records, honing in on specific sections (such as discharge summaries and operative reports) according to system edits and flagged items.

• Align clinical documentation within the medical record with the relevant ICD-10 codes to ensure DRG accuracy.

• Detect and rectify issues such as under coding or misclassification of diagnoses and procedures.

• Leverage Health ROI system edits to identify specific high-value opportunities (e.g., dialysis, occlusion, embolization, catheterization).

• Propose reimbursement enhancement strategies and present findings for client evaluation and approval.

• Work alongside leadership to prioritize cases and manage workflow effectively.

• Stay updated on coding revisions, payer policies, and DRG modifications to facilitate accurate recommendations.

• Analyze reporting for clients.

• Recognize new revenue opportunities associated with all components related to inpatient DRG.

⛳️ Requirements

• An associate's or bachelor’s degree in health information management or a related field is required. (Individuals credentialed as RHIT or RHIA are encouraged to apply).

• Certification as a Certified Coding Specialist (CCS) is mandatory.

• 2-3 years of experience in DRG validation, inpatient medical coding, or similar coding review roles.

• A solid understanding of ICD-10-CM/PCS coding guidelines, DRG reimbursement methods, and hospital billing procedures.

• Skilled in reading and interpreting clinical documentation across various departments (including nursing, operative, radiology, and pharmacy).

• Experience in a post-bill coding setting and familiarity with DRG grouping software and billing databases.

• An analytical mindset with a focus on financial implications and accuracy of reimbursement.

• Comfortable navigating multiple digital platforms, electronic medical records (EMRs), and data systems.

• Strong computer skills and proficiency in basic office applications, including MS Office (Word, Excel, and Outlook).

🏝️ Benefits

• EnableComp is an Equal Opportunity Employer M/F/D/V.

• We are dedicated to fostering a workplace environment that is free from all forms of discrimination or harassment.

• Ongoing commitment to the professional growth and development of our team members.

• Investing in our employees is fundamental to our success.