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DRG Validator/Reviewer (REMOTE)

1 month, 3 weeks ago
United States
Full-time
Junior
Operations Specialist
Operations
Apply Now
EnableComp

EnableComp

EnableComp specializes in complex claims and specialty revenue cycle management solutions for healthcare providers, focusing on optimizing reimbursements for various claims types, including VA, Workers' Compensation, and Motor Vehicle Accidents, throug...

Insurance
251-1K
Founded 2000
View All Jobs 16

Description

  • Review post-billed inpatient claims in the DRG database for diagnosis, procedure, grouping, and reimbursement accuracy.
  • Analyze weekly hospital billing files to identify underpaid claims using ICD-10 diagnosis and procedure codes.
  • Perform detailed post-bill medical record reviews to verify coding completeness and accuracy.
  • Navigate medical records to locate key documentation sections such as discharge summaries and operative reports.
  • Match clinical documentation to ICD-10 codes and correct undercoded or misclassified diagnoses and procedures.
  • Use system edits to identify high-value reimbursement opportunities and other revenue improvement cases.
  • Prepare reimbursement recommendations and submit findings for client review and approval.
  • Collaborate with leadership on case prioritization and workflow management.
  • Analyze client reporting and identify new inpatient DRG-related revenue opportunities.
  • Stay current on coding updates, payer guidelines, and DRG changes.

Requirements

  • Associate's or bachelor’s degree in health information management or a related field required; RHIT or RHIA credentialed individuals are encouraged.
  • Certified Coding Specialist (CCS) certification required.
  • 2-3 years of experience in DRG validation, inpatient medical coding, or related coding review.
  • Strong understanding of ICD-10-CM/PCS coding guidelines, DRG reimbursement methodology, and hospital billing processes.
  • Experience reading and interpreting clinical documentation across multiple departments.
  • Experience working in a post-bill coding environment with DRG grouping software and billing databases.
  • Comfort navigating multiple digital platforms, EMRs, and data systems.
  • Strong computer proficiency, including MS Office (Word, Excel, and Outlook).
  • Excellent communication, documentation, analytical, and problem-solving skills.
  • Ability to work independently, manage multiple priorities, meet deadlines, and handle high-volume workloads.
  • Strong attention to detail, professionalism, and high integrity in handling PHI and confidential information.
  • Proven experience working with external clients and strong customer service skills.
  • Primarily office-based or remote, depending on company policy.

Benefits

  • Multi-year Top Workplaces award winner.
  • Recognized as Black Book's #1 Specialty Revenue Cycle Management Solution provider in 2024.
  • Among the top one percent of companies on the Inc. 5000 list for the last eleven years.
  • Commitment to professional growth and development.
  • Supportive culture with tools, resources, and support to help employees thrive.
  • Flexible work environment with remote or office-based options, depending on company policy.
  • Work-life balance emphasized by employees in company testimonials.

Interested in this position?

Apply directly on the company website

Apply Now

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