Inpatient DRG Validator & Coding Analyst

Kodiak Solutions; United States; On-site; USD 90,000 - 120,000; Full time

Job summary

Kodiak Solutions, a healthcare technology company, is seeking an Inpatient DRG Validator & Coding Analyst to support revenue integrity and ensure coding accuracy across clients.

You will review ICD-10-CM/PCS coding, assess documentation for specificity, and collaborate with the Supervisor/ Manager of Revenue Integrity Services to optimize DRG reimbursement and data quality in hospital inpatient services.

Qualifications

• Minimum 5+ years’ experience with coding IP claims.
• Experience with ICD-10-CM/PCS and DRG validation.
• Experience with Medicare/Medicaid DRGs.
• Experience with DRG Validator.
• Knowledge of coding guidelines and regulatory requirements.

Responsibilities

• Review inpatient coding (ICD-10-CM/PCS) for accuracy and completeness.
• Validate codes and assignment to optimize DRG reimbursement.
• Assess physician documentation for specificity and quality.
• Identify opportunities to improve documentation and coding queries.
• Collaborate with client organizations and service line teams.

Skills

Communication skills

Healthcare domain knowledge

Analytical thinking

Attention to detail

Education

Bachelor's degree in Health Information Management / related field

Associates in Health Information Technology

RHIA or RHIT certification desirable

CCS credential

Tools

Cerner

EPIC

Meditech

MS Office / Excel

In-house coding software

Job description

At Kodiak Solutions, we’re dedicated to transforming the healthcare industry through cutting-edge, technology-driven solutions. We specialize in healthcare finance, unclaimed property, risk management, and revenue cycle management, helping healthcare organizations streamline complex financial operations. Our mission is to simplify and optimize processes, so healthcare providers can focus on delivering excellent patient care.

The Inpatient DRG Validator & Coding Analyst will work closely with the Supervisor/ Manager of Revenue Integrity Services to achieve the Revenue Integrity Service Line’s goals and objectives and Company-wide goals and initiatives. The Inpatient DRG Validator & Coding Analyst will be responsible for supporting the Kodiak Service Line by providing inpatient coding reviews, as well as supporting other Kodiak Service Lines.

Essential Duties and Responsibilities

include the following. Other duties may be assigned.

• Ability to read, decipher and analyze all aspects of medical record documentation for accurate coding.
• Responsible for reviewing inpatient coding (ICD-10-CM and ICD-10-PCS codes) to ensure accuracy and completeness of records coded by the coding staff for multiple clients.
• Validate the ICD-10-CM and PCS codes, principal and secondary diagnoses
• Assignment appropriateness to ensure consistency and efficiency and to optimize DRG reimbursement and facilitate data quality in hospital inpatient services.
• Review physician documentation for specificity, completeness, and quality to support coding accuracy, and to identify physician query opportunities to improve the documentation.
• Maintains current knowledge of regulatory agencies standards, i.e., CMS, OIG, AHA, Coding Clinics etc.
• Maintain required coding credential(s)
• Seeks opportunities for individual growth and development, including attending various meetings, conferences, and courses, as required,
• Responsible for meeting departmental productivity and quality expectations.
• Consult with client organizations and their department heads at the direction of the service line director.
• Collaborate with other service line team members to meet client demands and to develop strategies for service line growth and operational improvement.

Required Qualifications

• A minimum, 5+ years’ experience with Coding IP Claims
• CCS (Certified Coding Specialist) credential required
• Experience with Medicare and Medicaid DRGs.
• Experience with DRG Validator.
• Experience with OP coding a plus.
• Strong coding knowledge and follow the official coding rules, guidelines, and conventions to validate coded data and ensure high quality and compliance with regulatory requirements.
• Demonstrates competency in the use of computer applications in the EHR (i.e., Cerner, EPIC, Meditech, etc.) and knowledge in DRG grouping software.
• Computer proficiency as related to MS Office and in-house proprietary software.
• Demonstrates knowledge in hospital/healthcare settings such as revenue cycle, coding, and reimbursement.
• Knowledge of ICD-10-CM/PCS required
• ICD-10-CM/PCS AHIMA Approved Trainer experience highly desired.
• Excellent oral and written communication skills, including the ability to interact with high-level of management.
• Detailed-oriented and able to meet targeted deadlines.
• Bachelor of Science degree in a related field, Associates in Health Information Technology minimally acceptable
• RHIA or RHIT a plus, CCS credential required.

Candidates must be legally authorized to work in the United States. This position is not eligible for employment visa sponsorship now or in the future.