Remote DRG Validator & Coding Quality Reviewer

About the position

The Remote DRG Validator & Coding Quality Reviewer is responsible for performing inpatient coding and DRG validation, ensuring coding accuracy and compliance. This role involves conducting pre-billing data quality reviews of coding performed by both Client employees and vendor coders, with a focus on various types of accounts and compliance requirements. The position requires timely completion of reviews and collaboration with various stakeholders to enhance coding practices and documentation accuracy.

Responsibilities

• Perform inpatient coding and DRG validation and other reviews by verifying coding accuracy and compliance.
• Conduct pre-billing data quality reviews of Client employees and vendor coders' inpatient coding.
• Review mortality and potential PSI/HAC accounts on a pre-billing basis.
• Pre-review physician queries as requested and ensure appropriateness of queries sent to physicians.
• Provide direct written feedback to coders regarding coding errors and DRG changes identified.
• Participate in the review of all mortality accounts to capture all possible diagnoses affecting the mortality index.
• Assist with 100% pre-billing review of new coders' work as assigned.
• Collaborate with CDI related to documentation queries and coding questions from core measures abstractors.
• Correspond with Patient Accounts regarding questions related to codes submitted or claim errors.
• Provide education regarding specific coding guidelines or requirements for CDCI staff as needed.

Requirements

• Experience in inpatient coding and DRG validation.
• Knowledge of ICD-10 coding accuracy and hospital coding guidelines.
• Ability to perform pre-billing reviews within 24 hours of initial coding.
• Strong communication skills for providing feedback and collaborating with various departments.
• Familiarity with coding resources such as Coding Clinics and Clintegrity 360 encoder.

Nice-to-haves

• Experience with coding software evaluation and workflow enhancements.
• Knowledge of emerging technologies or treatment modalities in healthcare.
• Experience in providing continuing education to coding staff.

Benefits

• Medical, dental and vision benefits
• Earned time off and paid holidays
• Paid continuing education time
• 401(K) retirement planning
• Short-term disability
• Life insurance
• Paid jury duty
• Access to the largest network of facilities and providers in the country
• Licensure and certification reimbursement