Inpatient DRG Validation RN — Claims & Reimbursement

Molina Talent Acquisition; United States; On-site; USD 90,000 - 120,000; Full time

Benefits offered by this job

Benefits package

Job summary

Molina Healthcare seeks an RN with inpatient coding, clinical validation, and payment integrity experience. You will verify DRG accuracy, ICD-10 coding, and reimbursement methodologies against medical records and payer guidelines.

Responsibilities include DRG validation, itemized bill review, and providing evidence-based rationales for coding determinations while collaborating with physicians and analytics to improve reimbursement accuracy.

Qualifications

• Must have 2+ years of inpatient payment integrity claim review including DRG validation or itemized bill review.
• RN license active and unrestricted in state of practice.
• Expertise in UHDDS, CMS/Medicaid guidelines, ICD-10, DRG methodologies, CPT/HCPCS.

Responsibilities

• Review inpatient and outpatient claims to ensure diagnoses, procedures, revenue codes, and DRG assignments reflect documented conditions.
• Apply ICD-10 coding principles, DRG methodologies, and payer policies during reviews.
• Perform DRG validation by verifying diagnoses, complications, procedures, and grouping logic.
• Conduct itemized bill reviews to confirm charges are supported by documentation and compliant with standards.
• Develop clear, evidence-based rationales for coding recommendations and determinations.
• Collaborate with coding, analytics, and physician advisors to resolve discrepancies and improve reimbursement accuracy.

Skills

Critical thinking

Attention to detail

Verbal and written communication

Time management

Microsoft Office

Education

RN license (active in state of practice)

Job description

Molina Healthcare seeks an RN with inpatient coding, clinical validation, and payment integrity experience. You will verify DRG accuracy, ICD-10 coding, and reimbursement methodologies against medical records and payer guidelines.

Responsibilities include DRG validation, itemized bill review, and providing evidence-based rationales for coding determinations while collaborating with physicians and analytics to improve reimbursement accuracy.