Coding Manager DRG Validator - Hybrid

2600 White Plains Hospital Medical Center; Los Angeles (CA); On-site; USD 100,000 - 150,000; Full time

Job summary

White Plains Hospital Medical Center is seeking a Coding Manager/DRG Validator to oversee inpatient coding operations and DRG reimbursement, ensuring data quality and compliance across the HIM department. The role entails staff training, compliance reviews, and collaboration with external CDI initiatives to optimize hospital reimbursement.

The candidate should possess a Bachelor’s degree with CCS certification and substantial experience in CPT-4, ICD-10-CM-PCS, and DRG/MS-DRG groupers, with

Qualifications

• Bachelor degree required; CCS certification required.
• Seven+ years of coding experience; at least 5 years in coding management in acute care.
• In-depth knowledge of CPT-4 and ICD-10-CM-PCS; DRG validation; MS-DRG/APR-DRG groupers.

Responsibilities

• Oversee inpatient coding and DRG reimbursement processes.
• Ensure staff training on compliance policies and procedures.
• Review coding accuracy and drive process improvements.
• Collaborate with outside agencies for CDI initiatives.
• Manage HIM department operations and budget planning.

Skills

CCS Certification

RHIA/RHIT preferred

Coding management

DRG Validation

Leadership

Teamwork

Communication

Education

Bachelor’s Degree

CCS Certification

RHIA/RHIT preferred

Job description

Job Summary

The Coding Manager/DRG Validator oversees the daily operations of the HIM Department inclusive of Inpatient Coding, with responsibility for all processes and procedures including abstracting clinical information from a variety of Electronic Health Records and assignment of appropriate codes for diagnoses and procedures. The Manager/DRG validator is responsible for creating consistency and efficiency in inpatient claims processing and data collection to optimize DRG reimbursement and facilitate data quality in hospital inpatient services.

Essential Functions

Understands and adheres to WPH Performance Standards, Policies and Behaviors Keeps abreast of all pertinent federal, state and WPH regulations, laws and policies as they presently exist and as they are changed or modified. Ensures that all staff are trained and evaluated on their knowledge of and adherence to compliance policies and procedures specific to their job. Assures timely transmission of coded data to Patient Accounts Department. Serves as hospital resource on coding and DRG reimbursement. Oversees all compliance reviews especially Inpatient cases as necessary; initiates education/or corrective actions as necessary. Shares findings of coding reviews with Coders on a regular basis; initiates/education or corrective actions as necessary. Assures compliance with state regulatory and accreditations standards. Interviews, hires, trains, evaluate, counsels and terminate employees as per hospital policy. Conducts staff meetings as needed to update staff and/ or address department issues. Participates in committees, task forces, projects as required. Facilitates work with outside agencies with implementation of coding/cdi documentation improvement to ensure best practices which include compliance and increased revenue. Is responsible and accountable for overall operations of areas of responsibility within the HIM Department; overall operations include participation in the development of LEM goals that are consistent with the Hospital Pillar Goals, the management of personnel, monitoring of HIM budgets. Assists staff as needed to complete work, ensures that all expected standards in the process are working optimally, and pays attention to accuracy and turnaround time commitments. Identifies opportunities to streamline current operations where possible and implements approved procedural changes, problem solves, troubleshoots, and appropriately escalates issues to higher level management as necessary. Identifies opportunities to streamline current operations where possible and implements approved procedural changes, problem solves, troubleshoots, and appropriately escalates issues to higher level management as necessary. Performs all other related duties as assigned.

Qualifications

Bachelor Degree Required CCS Certification required. RHIA or RHIT credential preferred. Minimum of Seven (7) years of coding experience; with at least Five (5) years of Coding management experience, in acute care hospital Health Information Department; with extensive exposure to CPT-4 and ICD-10-CM-PCS coding, data entry and chart Clinical documentation. DRG Validation experience: Include excellent understanding of coding guidelines and in depth understanding of MS-DRG, and APR-DRG groupers to ensure optimal results for hospital in order to maintain high compliance and optimal reimbursement. Demonstrates ability to promote Teamwork among all HIM Staff Demonstrate leadership skills and empower staff to hardwire communication skills bidirectional. Must demonstrate excellent organizational, judgment, communication, and problem-solving techniques. Demonstrate stress tolerance with all exchanges of daily work May be exposed to chemicals necessary to perform required tasks. Any hazardous chemicals the employee may be exposed to are listed in the hospital’s SDS (Safety Data Sheet) data base and may be accessed through the hospital’s Intranet site (Employee Tools/SDS Access). A copy of the SDS data base can also be found at the hospital switchboard, saved on a disc. Manual dexterity is required for use of computer keyboard and mouse; Must be able to sit at computer terminal for extended amounts of time daily. Walking to different areas both inside and offsite locations Must be able to concentrate during times of increased noise level, changes in temperatures

White Plains Hospital Medical Center is an equal employment opportunity employer. White Plains Hospital Medical Center will recruit, hire, train, transfer, promote, layoff and discharge associates in all job classifications without regard to their race, color, religion, creed, national origin, alienage or citizenship status, age, gender, actual or presumed disability, history of disability, sexual orientation, gender identity, gender expression, genetic predisposition or carrier status, pregnancy, military status, marital status, or partnership status, or any other characteristic protected by law. White Plains Hospital is a proud member of the Montefiore Health System, serving as its tertiary hub of advanced care in the Hudson Valley. The Hospital is a 292-bed not-for-profit health care organization with the primary mission of providing exceptional acute and preventive medical care to all people who live in, work in or visit Westchester County and its surrounding areas. White Plains Hospital has outpatient medical facilities across Westchester, including multispecialty practices in Armonk, Hawthorne, Larchmont, New Rochelle, Rye Brook, Scarsdale, Somers, Yonkers and Yorktown Heights; and Scarsdale Medical Group locations in Harrison and Scarsdale. The Hospital is fully accredited by the Joint Commission, and in 2025 received another 5-star rating from the Centers for Medicare & Medicaid Services (CMS) — the highest distinction offered by the federal agency – for the fourth consecutive year. In addition, the Hospital received its third Magnet® designation from the American Nurses Credentialing Center (ANCC), a distinction held by only two percent of hospitals in the country. White Plains Hospital has consistently received the Outstanding Patient Experience Award from Healthgrades®, and in 2025 was awarded an “A” Safety Grade from the Leapfrog Group for the 14th consecutive time.