Remote DRG Validation Specialist | Coding Quality & Audit

PC Recruiter; Raleigh (NC); Remote; USD 90,000 - 110,000; Full time

Job summary

PC Recruiter has an immediate remote opening for a DRG Validation Specialist with a top teaching hospital. The role focuses on reviewing DRG assignments, coding accuracy, and data analysis to support reimbursement and compliance.

Ideal candidates will have 5+ years inpatient coding experience, 2+ years quality improvement audits, and strong knowledge of ICD-9/ICD-10, CPT and DRG methodologies. RHIT/RHIA preferred.

Qualifications

• Associate's degree or higher.
• Minimum of 5 years of inpatient coding experience in a complex healthcare environment.
• Minimum 2 years of quality improvement audit.
• Experience and thorough knowledge of ICD-9, ICD-10, CPT and DRG methodologies.
• Knowledge of data reporting requirements and proficiency in computer skills.
• Extensive knowledge in data collection and clinical reviews.
• Excellent written, verbal, and interpersonal communication skills.

Responsibilities

• Reviews DRG assignment for Medicare/Medicaid inpatients, HAC, PSI and Healthgrade target diagnoses for reimbursement, research and statistics.
• Analyzes physician documentation for coding accuracy and queries physicians when documentation is unclear for coding purposes.
• Provides guidance to Inpatient Coders and educates on coding guidelines.
• Analyzes CDMP Severity Complexity worksheets and applies tracking codes.
• Guides Clinical Documentation Specialists with input and education on coding guidelines.
• Performs monthly data analysis and statistics on DRG, CPT, Public Reporting, HAC compliance.
• Makes recommendations on documentation improvement to improve patient care.
• Applies POA indicators on inpatient charts.
• Raises concerns to supervisor or department manager for resolution.
• Enters diagnosis and procedure codes into the 3M coding system and charts abstracted information.
• Assists Inpatient HIM Supervisor and Coding Manager with education sessions.
• Assists in chart completion to meet DNFB goals.
• Participates in in-house audits or audits of contract coders.
• Creates spreadsheets and summarizes findings.
• Attends monthly coding in-services.
• Keeps abreast of coding guidelines and CMS requirements.

Skills

Inpatient coding

Quality improvement

Data analysis

Documentation accuracy

Communication skills

Education

Associate's degree or higher

Tools

3M Coding system

Job description

PC Recruiter has an immediate remote opening for a DRG Validation Specialist with a top teaching hospital. The role focuses on reviewing DRG assignments, coding accuracy, and data analysis to support reimbursement and compliance.

Ideal candidates will have 5+ years inpatient coding experience, 2+ years quality improvement audits, and strong knowledge of ICD-9/ICD-10, CPT and DRG methodologies. RHIT/RHIA preferred.