Inpatient Clinical Validation RN – DRG & Reimbursement Pro

Molina Healthcare; United States; On-site; USD 36,000 - 79,000; Full time

Benefits offered by this job

Competitive benefits

Job summary

Molina Healthcare seeks an RN with inpatient coding, DRG validation, and clinical documentation review experience to support inpatient and outpatient claims. You will verify diagnoses, procedures, revenue codes, and DRG assignments reflect documentation and reimbursement rules.

The role focuses on applying ICD-10/DRG guidelines, CMS and state billing rules, and ensuring accuracy of charge capture while maintaining documentation integrity across complex cases.

Qualifications

• 2+ years in inpatient payment integrity medical claim review including DRG validation or itemized bill review.
• Active RN license in state of practice.

Responsibilities

• ,

Skills

Inpatient coding

DRG validation

MS-DRG/AP-DRG

ICD-10

CPT/HCPCS

CMS guidelines

UHDDS definitions

clinical documentation review

clinical judgment

communication skills

Education

RN license

CCS/RHIA/RHIT/CIC/CDIP/CPC (preferred)

nursing experience in critical care (preferred)

Tools

Microsoft Office

Job description

Molina Healthcare seeks an RN with inpatient coding, DRG validation, and clinical documentation review experience to support inpatient and outpatient claims. You will verify diagnoses, procedures, revenue codes, and DRG assignments reflect documentation and reimbursement rules.

The role focuses on applying ICD-10/DRG guidelines, CMS and state billing rules, and ensuring accuracy of charge capture while maintaining documentation integrity across complex cases.