APR-DRG Validator

Job Title: APR-DRG Validator

Location: remote, can sit anywhere in the US as long as you can work EST hours

Pay: $30-38/hr

Hours: Mon-Fri, 8 hours between 7am-5:30pm EST

Duration: long term open ended contract (includes benefits, sick time, 401k, weekly pay)

Job Specification

We’re seeking a DRG validator NOT a coder. Reviews inpatient medical records to ensure ICD-10 coding and APR-DRG assignments are accurate, compliant, and appropriately reimbursed. This role focuses on APR-DRG inpatient coding disputes and audit reviews, collaborating with our senior coders to ensure accuracy, compliance, and high-quality outcomes. The Inpatient DRG Validator is responsible for auditing inpatient medical records and generating high quality recoverable claims for the benefit of the company and its client. Also, the APR-DRG auditor is responsible for performing clinical reviews of medical records and other documentations to evaluate issues of coding and DRG assignment accuracy. Specializes in reviewing DRG coding in medical record sent in by acute care hospitals on submitted DRG. We are specifically looking for experienced auditors with strong ICD-10-CM/PCS knowledge and credentials such as RHIA, RHIT, CCS, CIC ONLY.

Responsibilities:

Abilities to analyze and audits claims by integrating medical chart coding principles, clinical guidelines and objectivity in the performance of medical audit activities.

Exhibit advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions of audits claims.

Utilizes audit tools and auditing workflow systems and reference information to make audit determinations and generate audit findings letters by providing recommendations to change, delete, or modify DRG’s.

Maintains accuracy and quality standards as set by auditing concept, valid claim identification, and documentation purposes consistent with rationale in the letter generated.

Ability to Identifies new claim by identifying potential claims where additional recoveries may be available, such as re-admissions DRG optimization and HACs.

Manages priorities, collaborates with peers and ensures timely completion of inpatient coding reviews. Suggests and recommends high quality, high value concept and or process improvement and efficiency recommendations when possible.

Required Qualifications:

RHIA, RHIT, CCS and CIC certifications have held for at least one of these qualifications for a minimum of 3 years

APR-DRG coding and auditing experience

3 years plus experience performing inpatient coding reviews and audits in inpatient patient hospital settings

Ability to work independently and determine appropriate courses of action with less supervision.

Excellent communication skills both written and verbal which is a crucial part of DRG audit

General Knowledge of Microsoft office programs such as word, PowerPoint, access, and Excel

Preferred Qualifications:

Associate degree or higher in Health information Management (HIT)

Experience in APR-DRG coding and auditing

Experience with 3M encoder

Experience with cost outlier and recovery is a plus.