Remote DRG Validator

• Conduct concurrent and retrospective clinical validation audits to ensure accurate MS-DRG and APR-DRG assignment in accordance with UHDDS requirements, Medicare guidelines, and applicable federal and state regulations.
• Review and validate ICD-10-CM diagnosis coding and ICD-10-PCS procedure coding for accuracy and compliance.
• Utilize electronic medical records, coding encoders, and audit software (e.g., 3M, Epic, TruCode) to support clinical validation and coding review activities.
• Develop detailed audit findings and clear, evidence-based rationales to support review outcomes.
• Prepare and issue physician queries to clarify clinical documentation and improve coding accuracy.
• Provide coding education and feedback to coding professionals using Official Coding Guidelines, AHA Coding Clinic references, and industry best practices.
• Evaluate coding and DRG-related denials and prepare comprehensive appeal responses for payers, RACs, PROs, and third-party auditors.
• Recommend appropriate coding, DRG assignment, severity of illness (SOI), and documentation improvements.
• Maintain current knowledge of coding regulations, reimbursement methodologies, and industry updates.
• Consistently achieve established productivity, quality, and accuracy benchmarks.
• Collaborate with physicians, Clinical Documentation Integrity (CDI) teams, coders, and other healthcare professionals to promote compliant documentation and coding practices.

Do you have experience in Video conferencing systems operation?, * AHIMA credential required: CCS, RHIT, or RHIA.

• Minimum of 5 years of experience in clinical validation, DRG auditing, coding quality review, claims auditing, recovery auditing, or related healthcare revenue cycle functions.
• Extensive experience with ICD-10-CM, ICD-10-PCS, MS-DRG, and APR-DRG methodologies.
• Strong understanding of medical terminology, anatomy and physiology, reimbursement systems, CPT coding, modifiers, and payer-specific requirements.
• Expert knowledge of Official Coding Guidelines, AHA Coding Clinic publications, CMS regulations, and healthcare compliance standards.
• Proficiency with Microsoft Office applications (Outlook, Word, Excel, PowerPoint) and healthcare auditing/coding platforms including 3M, TruCode, Microsoft Teams, and SharePoint., * Excellent written and verbal communication skills with the ability to effectively educate and influence clinical and coding staff.
• Strong analytical, critical-thinking, and problem-solving abilities with exceptional attention to detail.
• Self-motivated and able to work independently while managing multiple priorities and deadlines.
• Demonstrated ability to meet or exceed productivity, quality, and turnaround-time expectations.