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Date Added: Tue 08/06/2021

DRG Validator

Atlanta, GA, US
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Job Type: Permanent, FullTime

The DRG Validator, is responsible for reviewing medical records in accordance with UHDDS Definitions to validate an inpatient admit order, assignment of and sequencing of ICD-9-CM/ICD-10-CM/PCS principal and secondary diagnoses, principal and secondary procedures, the discharge disposition codes and the DRG Assignment. This position will review records for appropriate assignment of severity of illness and risk of mortality utilizing the APR DRG. The DRG Validator assists the Coding Quality Education Coordinator with ideas for education based on audit findings.
  • BA in a health services discipline. Formal HIM education with national certification (RHIA, RHIT). Coding certification (CCS) preferred from AHIMA.
  • Five (5) years progressive coding in an acute care facility and coding review experience in ICD-9-CM/ICD-10-CM/PCS with claims processing and/or data management responsibilities a plus. Past auditing experience or strong training background in coding and reimbursement preferred.
  • RHIA, RHIT required. CCS, Preferred ICD-10-CM/PCS.
  • Good oral and written communication skills and comprehensive knowledge of the MS_DRG structure and regulatory requirements. Knowledge of 3M Encoder, Computer Assisted Coding (CAC), Audit Expert, and Epic.
  • Extensive working knowledge of Medicare, Medicaid and Commercial Provider reimbursement methodologies to assist Patient Financial Services when needed.
  • Abreast of the current Office of Inspector General (OIG) work plans for DRG risk areas.
Equal Opportunity Employer-Minorities/Females/Veterans/Individuals with Disabilities/Sexual Orientation/Gender Identity.
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