DIAGNOSIS RELATED GROUP SPECIALIST
About The Position
The DRG Validator is a coding quality and compliance professional responsible for conducting complex and high-impact coding audits across inpatient (IP) encounters. Validates code accuracy, guideline compliance, and documentation support to ensure coding integrity and reduce denial risk. This role supports organizational coding quality initiatives by identifying audit trends, performing root cause analysis, ensuring audit defensibility, providing coder feedback, and supporting coding education strategies. The DRG Validator is required to use approved audit tools and scrubbers, including PWC SMART, to support audit targeting, audit documentation, and review consistency.
Requirements
- High School Diploma or equivalent required
- CCS required
- Demonstrated expertise in DRG and inpatient coding principles required if assigned to IP audits
- Expert-level knowledge of official coding guidelines and sequencing rules
- Strong clinical documentation interpretation skills
- Ability to apply independent professional judgment in audit conclusions
- Ability to clearly articulate and defend audit outcomes using guidelines
- Strong written communication skills for defensible documentation
- Strong attention to detail, productivity focus, and ability to meet strict deadlines
- Ability to work independently with minimal supervision while remaining accountable for quality and timeliness
Nice To Haves
- Associate’s or Bachelor’s degree preferred
- RHIA/RHIT, CPC, CRC, CDIP, or CCDS preferred
- Minimum of 5 years coding experience preferred (acute care strongly preferred)
- Minimum of 2 years auditing/quality review experience preferred
- Proficiency in Epic and related coding/audit tools preferred
Responsibilities
- Conducting complex and high-impact coding audits across inpatient (IP) encounters.
- Validating code accuracy, guideline compliance, and documentation support to ensure coding integrity and reduce denial risk.
- Identifying audit trends, performing root cause analysis, ensuring audit defensibility, providing coder feedback, and supporting coding education strategies.
- Using approved audit tools and scrubbers, including PWC SMART, to support audit targeting, audit documentation, and review consistency.
Benefits
- An assortment of insurance products and discount programs through Voluntary Benefits
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
