Senior Remote DRG Validation Nurse

TalentLNX LLC; United States; À distance; USD 70 000 - 90 000; Plein temps

Résumé du poste

TalentLNX LLC is seeking a remote DRG Clinical Validation Nurse to join an established inpatient clinical review team. You will examine inpatient records from admission through discharge to confirm that coded diagnoses, procedures, and DRG assignments accurately reflect the patient’s clinical picture.

This full-time, direct-hire role blends acute care nursing with inpatient coding and reimbursement knowledge and is fully remote, offering stability and opportunities to impact hospital

Qualifications

• Active, unrestricted compact (multistate) RN license.
• 3+ years of acute care nursing in ICU, ED, step down, or other high acuity setting.
• 2+ years of inpatient DRG validation, clinical validation, or inpatient record audit experience.
• Solid understanding of MS-DRG and APR-DRG grouping, including CC/MCC impact on reimbursement.
• Ability to apply ICD-10-CM and ICD-10-PCS guidelines to diagnosis selection and coding.
• Experience using encoder and grouper tools.
• Self-directed work style with ability to meet productivity and quality goals remotely.

Responsabilités

• Examine inpatient records to confirm principal and secondary diagnoses, procedures, and DRG accuracy.
• Assess whether complications and comorbidities are supported by labs, vitals, imaging, meds, and physician notes.
• Determine clinical validity of high impact conditions under APR-DRG.
• Evaluate how documented conditions affect severity of illness and mortality risk.
• Apply ICD guidelines and CMS requirements to determinations.
• Recommend DRG changes when records do not support billing; document rationale clearly.
• Write audit rationales that are concise and defendable in appeals.
• Assist with appeal responses by researching criteria and guidance.
• Meet targets for productivity, accuracy, and turnaround time.
• Share knowledge with peers and support onboarding of new staff.
• Stay current on annual coding updates and reimbursement rules.

Connaissances

Active RN license

Acute care nursing

DRG validation experience

Remote work capability

Outils

Encoder tools

Grouper tools

Description du poste

TalentLNX LLC is seeking a remote DRG Clinical Validation Nurse to join an established inpatient clinical review team. You will examine inpatient records from admission through discharge to confirm that coded diagnoses, procedures, and DRG assignments accurately reflect the patient’s clinical picture.

This full-time, direct-hire role blends acute care nursing with inpatient coding and reimbursement knowledge and is fully remote, offering stability and opportunities to impact hospital