Inpatient DRG Auditor & Code Quality Specialist

gmh; Atlanta (GA); On-site; USD 65,000 - 90,000; Full time

Job summary

Grady Health System in Atlanta seeks a DRG Validator to review inpatient coded records per UHDDS, validate ICD-10-CM/PCS assignments, and collaborate with CDI for SOI/ROM assessment. The role requires strong knowledge of MS-DRG/APR-DRG and AHA guidelines, with attention to accuracy and documentation quality.

You will perform chart reviews, assist in pre-bill reviews, and support education initiatives with Coding and CDI teams while leveraging SMART tools for data insights.

Qualifications

• 2 years auditing experience or strong training background in coding and reimbursement.
• 5 years progressive inpatient coding in an acute care hospital and ICD-10-CM/PCS review.
• Experience with Epic System is a plus.

Responsibilities

• Performs daily coding reviews for HACs, PSIs and focused DRGs on inpatient records identified by SMART to validate ICD-10-CM/PCS codes and POA assignment.
• Sends notifications to Quality Department for Quality Level reviews on cases where PSI/HAC indicators align with documentation.
• Reviews selected records to validate secondary diagnoses and procedures for compliance with reporting requirements.
• Writes concise rationale to support audit findings and DRGReview letters with applicable guidelines.
• Evaluates clinical documentation quality to identify incomplete or ambiguous inpatient documentation affecting DRG assignment.
• Using SMART Tool, performs data analysis to identify coding trends and informs CDI opportunities.

Skills

Auditing experience

Inpatient coding

Coding & reimbursement

Education

BA Health Administration

Tools

Epic System

Job description

Grady Health System in Atlanta seeks a DRG Validator to review inpatient coded records per UHDDS, validate ICD-10-CM/PCS assignments, and collaborate with CDI for SOI/ROM assessment. The role requires strong knowledge of MS-DRG/APR-DRG and AHA guidelines, with attention to accuracy and documentation quality.

You will perform chart reviews, assist in pre-bill reviews, and support education initiatives with Coding and CDI teams while leveraging SMART tools for data insights.