Inpatient DRG Validation Specialist | Coding QA

Grady Memorial Hospital Corporation; Atlanta (GA); On-site; USD 75,000 - 110,000; Full time

Benefits offered by this job

Health & Wellness

Financial Security

Work-Life Balance

Career Growth

Employee Support

Job summary

Grady Health System in Atlanta seeks a DRG Validator to review inpatient records for UHDDS definitions and DRG assignment using ICD-10-CM/PCS coding standards. Collaborates with CDI, Quality, and Coding teams to ensure accurate SOI/ROM and POA indicators.

The role requires auditing experience, inpatient coding expertise, and familiarity with Epic Systems. The successful candidate will support audit education and perform chart reviews to improve data quality and reimbursement.

Qualifications

• 2 years auditing experience or strong training background in coding and reimbursement.
• 5 years Progressive inpatient coding in an acute care hospital and coding review experience in ICD-10-CM/PCS.
• Claims processing and/or data management responsibilities, a plus.
• Experience with Epic System, a plus.

Responsibilities

• Performs daily coding reviews for HACs, selected PSIs and focused DRGs on inpatient records identified by SMART to validate the assigned ICD-10 CM/PCS Codes and Present of Admission (POA) assignment.
• Send notifications to the Quality Department (Quality Reviewer) to conduct a Quality Level review on cases in which the PSI/HAC Diagnosis and/or POA indicators are in alignment with documentation.
• Reviews selected records, validating secondary diagnoses and procedures to ensure compliance with all reporting requirements.
• Ability to write concise rationale to support audit findings and DRG Claim Review Appeal letters, referencing applicable official guidelines, when applicable.
• Evaluates the quality of clinical documentation to identify incomplete or ambiguous documentation for inpatient encounters that impact the code selection and resulting DRG assignment and reimbursement.
• Utilizing SMART Tool, ability to perform data analysis and identify trends for Coding/CDI opportunities and provide feedback to assure coding uniformity, consistency and accuracy with ICD-10-CM/PCS.
• Works closely with the Clinical Documentation Improvement Manager in pre-bill review of Mortality charts and Hospital Acquired Conditions (HACs), and specific diagnosis or DRG's as assigned.
• Collaborates with the Coding Vendor to provide input for development of educational areas for inpatient coding involving both internal and external training.
• Works jointly with Independent Coding Auditor regarding recommendations for revisions to diagnoses and/or procedures, queries and HIM DRG spreadsheet.
• Works with Executive Director of HIM and Corporate Coding & Reimbursement Manager to develop process improvements to maintain data quality.
• As needed, assist with coding of accounts.
• Completes special projects as assigned, other duties as assigned.

Skills

Auditing

Inpatient coding

ICD-10-CM/PCS

POA indicators

Quality data analysis

Education

BA Health Administration

Tools

Epic Systems

Job description

Grady Health System in Atlanta seeks a DRG Validator to review inpatient records for UHDDS definitions and DRG assignment using ICD-10-CM/PCS coding standards. Collaborates with CDI, Quality, and Coding teams to ensure accurate SOI/ROM and POA indicators.

The role requires auditing experience, inpatient coding expertise, and familiarity with Epic Systems. The successful candidate will support audit education and perform chart reviews to improve data quality and reimbursement.