We are a large academic acute care medical center located in Manhattan and an integrated health care system providing exceptional medical care to our local and global communities.
We are looking to hire an experienced DRG Validator (full-time/permanent) to join our busy DRG department while working 100% remote. As the DRG Validator you will confirm that diagnostic, procedural information, and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician’s description and the information contained in the beneficiary’s medical record, and perform quality reviews of medical records and more.
Position: DRG Validator
Location: REMOTE
Salary: $80,000 - $118,000 (Based on DRG inpatient experience)
Responsibilities:
- Validates the accuracy and appropriateness of the DRG assignments flagged pre-billing determining if a secondary review is required to verify assignment of Patient Safety Indicators, HAC, Clinical Documentation Improvement, Sepsis and any other charts meeting criteria for secondary review
- Initiates an MD query to clarify documentation in the medical record for documentation, integrity and accurate code assignment essential to support documentation of medical diagnoses or conditions that are clinically evident
- Reviews coder queries to determine if the query is supported and generates query to provider as well as reviewing cases with coding and/or DRG changes proposed by insurers, vendors, PFS to reconcile coding and/or DRG discrepancies
- Provides feedback to coders on all coding changes thru SMART by documenting detailed rationale for change and updates Artifact, 3M-360 and HDM with all query responses and selects the correct response to designate impact
- Reviews and reconciles DRG discrepancies between DRGS/APR’s and the Clinical Documentation Quality Improvement (CDQI) department. Develops and maintains a close working relationship with CDQI staff
Requirements:
- Must have a CCS and a strong background in anatomy, physiology, pharmacology
- Three (3) to five (5) years of related experience as an INPATIENT HOSPITAL DRG Validator with ICD-10-CM and ICD-10-PCS coding is required as well as auditing
- Excellent current knowledge of MS-DRGs, APR-DRGs reimbursement methodology
- Strong working knowledge of electronic health records, registration and data systems.
Job Type: Full-time
Pay: $80,000.00 - $118,000.00 per year
Benefits:
- 401(k)
- Dental insurance
- Disability insurance
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Tuition reimbursement
- Vision insurance
Schedule:
- Day shift
- Monday to Friday
Work setting:
Work Location: Remote