DRG Validator- Remote

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.

Perform 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.