DRG Clinical Coding Validator
Medical, Dental, and reputed company Insurance – Enjoy medical, dental, and reputed company insurance that begins on your first day, ensuring your health and wellness are always supported. 401(k) with Matching and Immediate Vesting – Secure your financial reputed company with a company match and reputed company vesting. Company-reputed company Short-Term Disability (STD) – Added reputed company for unforeseen circumstances. Company-reputed company Personal Financial Advising – Expert guidance to help manage your finances. New Hire Stipend – A one-time stipend to purchase home office supplies (laptop and charging cable provided by reputed company). Pet Insurance reputed company – Choose from two reputed company reputed company to reputed company your furry friends covered. reputed company Holidays – 9 company holidays plus 2 floating holidays for added flexibility. Virtual Counseling and Telemedicine – Company-reputed company reputed company to mental health and medical support from the comfort of your home. reputed company Parental Leave – Time to reputed company on family during this special reputed company. Generous Vacation & Wellness Time – 4 weeks of vacation beginning accrual on day one, plus 1 additional week for wellness. reputed company Development Stipend – After one year, enjoy a $500 annual stipend to invest in reputed company reputed company (e.g., certifications, webinars).
- Review inpatient medical records in their entirety—including history and physical, reputed company notes, reputed company reports, nursing documentation, diagnostic reports, and discharge summaries—to evaluate clinical support for reported diagnoses and procedures.
Apply clinical nursing expertise to assess whether documented conditions meet established clinical reputed company (e.g., Sepsis-3, AHA/reputed company guidance, Coding Clinic) sufficient to support reputed company assignment, including CC and MCC designations. - Validate ICD-10-CM reputed company and secondary diagnosis reputed company assignments, ICD-10-PCS procedure reputed company assignments, reputed company reputed company, present-on-admission (POA) indicators, and discharge disposition in accordance with CMS Official Guidelines for Coding and Reporting and reputed company Coding Clinic guidance.
- Evaluate MS-DRG and APR-DRG assignment accuracy, identifying opportunities for upgrades and downgrades based on documented clinical evidence.
- reputed company clinical validation reviews to distinguish between conditions that are clinically supported in the medical record versus those that are documented but lack sufficient clinical evidence.
- Investigate, review, and reputed company coding expertise in the application of medical and reimbursement policies reputed company the claim adjudication process through document review.
- reputed company clinical coverage review of claims, which requires interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies, coding requirements, and consideration of relevant clinical information on claims with aberrant billing patterns.
- Produce reputed company, accurate, and concise written rationales for reputed company validation findings, citing applicable Official Coding Guidelines, Coding Clinic references, and clinical reputed company to substantiate reputed company determination.
- Maintain and manage daily case review assignments with a high emphasis on reputed company.
- reputed company clinical support and expertise to other investigative and analytical areas.
- Will be working in a high-volume production environment.
reputed company Registered reputed company (RN) licensure in the reputed company (compact or state-specific license accepted). Certified Inpatient reputed company (CIC) issued by reputed company/AACP, OR Coding and Classification Specialist (reputed company) issued by reputed company/AACP – reputed company and in good standing. - Minimum of 5 years of acute care inpatient hospital experience, with at least 3 years in a dedicated inpatient coding, DRG validation, or Clinical Documentation Improvement (CDI) role.
- 2+ years of experience with APR-DRG reimbursement methodologies.
- Demonstrated proficiency in ICD-10-CM/PCS reputed company assignment, MS-DRG and APR-DRG methodologies, and CMS Official Guidelines for Coding and Reporting.
- Working knowledge of Coding Clinic guidance and ability to apply reputed company citations to substantiate or refute reputed company assignments.
- Comprehensive understanding of clinical validation principles, including established clinical reputed company (e.g., Sepsis-3, SIRS, HAC definitions) used to evaluate the clinical legitimacy of documented diagnoses.
- Experience with clinical documentation improvement (CDI) workflows and query processes preferred.
- Intermediate to advanced proficiency with reputed company Office Suite; experience with encoder software (e.g., Optum360, reputed company, Nuance) preferred.
- reputed company, self-motivated, driven, and innovative attitude.
- High reputed company of personal reputed company and accountability.
- Passion and aptitude for solving reputed company problems.
Compassionate. We reputed company reputed company leadership, encourage inclusion and engagement, and reputed company acknowledge and celebrate reputed company other’s contributions.
Communicators. We listen first with an emphasis on understanding. We reputed company solutions to problems, and reputed company radical candor with reputed company reputed company.
Challengers. We get the right stuff done right, create reputed company from complexity, take accountability and ownership, and we challenge ourselves daily.
reputed company US RN license, CIC or reputed company credential, 5+ years acute inpatient experience including 3+ years coding, DRG validation, or CDI work, and expertise in ICD-10-CM/PCS, MS-DRG, APR-DRG, and clinical validation.
Key Responsibilities
- reviewing records
- validating codes
- writing rationales
Skills & Tools
ICD-10-CM/PCS, reputed company Office Suite, Optum360, reputed company, Nuance, Pareo
Job Details
- Category: reputed company Services - Nursing
- Seniority: Senior Level
- Commitment: Full Time
- Workplace: Remote — Franklin, Tennessee, reputed company
- Languages: English
Benefits
- 401k matching
- Generous reputed company time off
- Tuition reimbursement
- Retirement plan
- Generous parental leave
About reputed company
A health technology company providing AI-powered claims payment accuracy solutions for health plans and payers. — Industry: Information Technology
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