Inpatient DRG Validator & Coding Auditor

Grady Health System; Atlanta (GA); On-site; USD 85,000 - 110,000; Full time

Benefits offered by this job

Health & Wellness plan

Retirement savings with employer"s"

Paid time off

Tuition reimbursement

Job summary

Grady Health System in Atlanta seeks a DRG Validator to review inpatient coded records, validate ICD-10-CM/PCS coding, and ensure accurate DRG assignments per UHDDS guidelines. The role collaborates with Quality and CDI teams for higher accuracy and supports education through audit findings.

The ideal candidate has inpatient coding experience, familiarity with MS-DRG/APR-DRG concepts, and Epic Systems proficiency, with a focus on improving 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

Coding review

ICD-10-CM/PCS

POA Guidelines

MS-DRG knowledge

Epic System

Education

BA Health Administration

MGNT-Certified Coding Specialist - AHIMA

Registered Health Information Technician - AHIMA

Certified Clinical Documentation Specialist (CCDS)

Certified Documentation Improvement Practitioner (CDIP)

Tools

Epic System

Job description

Grady Health System in Atlanta seeks a DRG Validator to review inpatient coded records, validate ICD-10-CM/PCS coding, and ensure accurate DRG assignments per UHDDS guidelines. The role collaborates with Quality and CDI teams for higher accuracy and supports education through audit findings.

The ideal candidate has inpatient coding experience, familiarity with MS-DRG/APR-DRG concepts, and Epic Systems proficiency, with a focus on improving data quality and reimbursement.