DRG Coding & Clinical Validation Analyst I–III

Capital District Physicians Health Plan Inc; Village of Bronxville (NY); Hybrid; USD 65,346 - 117,622; Full time

Benefits offered by this job

Group health insurance

Dental insurance

Retirement plan

Paid time off

Paid holidays

Job summary

A healthcare provider in Bronxville is looking for a Payment Integrity DRG Coding & Clinical Validation Analyst to review medical records for accurate coding and documentation. The ideal candidate should have extensive coding knowledge, along with experience in claims auditing and familiarity with ICD-10CM and DRG systems. This role involves analyzing inpatient claims, ensuring compliance with coding guidelines, and mentoring new hires. Opportunities exist for remote work depending on the case.

Qualifications

• Three years experience in claims auditing for hospital or acute facility setting.
• Intermediate analytical and problem-solving skills required.
• Coding certification (RHIA, RHIT, CCS, or CIC) must be maintained.

Responsibilities

• Analyze and audit acute inpatient claims for accuracy.
• Ensure compliance with coding guidelines and regulations.
• Oversee complex assignments and mentor new hires.

Skills

Auditing

Analytical skills

ICD-10CM knowledge

DRG coding

Education

Associate or bachelor's degree in health information management

Tools

Claims processing systems

Job description

A healthcare provider in Bronxville is looking for a Payment Integrity DRG Coding & Clinical Validation Analyst to review medical records for accurate coding and documentation. The ideal candidate should have extensive coding knowledge, along with experience in claims auditing and familiarity with ICD-10CM and DRG systems. This role involves analyzing inpatient claims, ensuring compliance with coding guidelines, and mentoring new hires. Opportunities exist for remote work depending on the case.