DRG Validation Specialist: ICD-10 & Reimbursement Expert

EnableComp LLC; United States; Hybrid; USD 70,000 - 100,000; Full time

Job summary

EnableComp seeks a DRG Validator/Reviewer to audit post-billed inpatient claims and identify missed reimbursement opportunities using ICD-10 coding within a DRG database. Certified Coding Specialist (CCS) required, with strong knowledge of documentation and DRG methodologies.

This role handles PHI with strict privacy and security controls. The candidate will review medical records, analyze coding accuracy, and provide recommendations to optimize hospital reimbursement, collaborating with

Qualifications

• Associate's or bachelor’s degree in health information management or related field.
• CCS certification required.
• 2-3 years’ experience in DRG validation, inpatient medical coding, or related coding review.
• Strong understanding of ICD-10-CM/PCS coding guidelines and DRG reimbursement methodology.
• Proficient reading and interpretation of clinical documentation across departments.

Responsibilities

• Review inpatient claims in the DRG database focusing on diagnosis, procedures, grouping logic, and reimbursement accuracy.
• Analyze weekly hospital billing files to identify underpaid claims based on ICD-10 codes.
• Conduct post-bill medical record reviews to verify codes are accurate and complete.
• Identify and correct under coded or misclassified diagnoses and procedures.
• Assist with client reporting and recommendations for reimbursement improvements.

Skills

Analytical thinking

Communication skills

Attention to detail

Documentation reading

Education

Associate's or bachelor's degree in health information management or related field

Tools

DRG grouping software

Billing databases

Job description

EnableComp seeks a DRG Validator/Reviewer to audit post-billed inpatient claims and identify missed reimbursement opportunities using ICD-10 coding within a DRG database. Certified Coding Specialist (CCS) required, with strong knowledge of documentation and DRG methodologies.

This role handles PHI with strict privacy and security controls. The candidate will review medical records, analyze coding accuracy, and provide recommendations to optimize hospital reimbursement, collaborating with