DRG Validation Auditor

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STAR Medical Auditing Services is a boutique consulting firm that provides Health Information Management (HIM) and Clinical services to various organizations in the healthcare ecosystem across the U.S. We pride ourselves in providing high-quality services that are tailored to our clients’ specific needs, while creating joyful experiences along the way by treating everyone with respect and care.

Must reside and be legal to work in the U.S.

Overview:

The DRG (Diagnosis-Related Group) Validator is responsible for ensuring the accuracy and compliance of assigned DRG codes on inpatient claims. This role plays a critical part in revenue integrity, clinical documentation improvement, and compliance with federal and state regulations. The validator reviews medical records, coding, and billing data to confirm that DRG assignments are correct and supported by clinical documentation.

We are particularly interested in candidates with an active and unrestricted RN or LPN license and coding credential who have DRG Coding and Clinical Validation experience!!!

Key Responsibilities

  • Review inpatient medical records for appropriate ICD-10-CM and ICD-10-PCS coding.
  • Validate DRG assignments to ensure compliance with CMS and payer guidelines.
  • Identify potential coding errors, missed opportunities, or documentation deficiencies.
  • Prepare detailed audit reports with findings, corrections, and recommendations.
  • Monitor coding trends and identify areas of risk for revenue leakage or compliance issues.
  • Stay current with ICD-10-CM/PCS coding guidelines, CMS updates, and regulatory changes.
  • Meets or Exceeds Standards/Guidelines for Productivity. Maintains production goals set by the audit operations management team.
  • Meets or Exceed Standards/Guidelines for Accuracy and Quality. Achieves the expected level of accuracy and quality set by the audit operations management team of 97% or higher.

Required Qualifications

  • Certification:
  • AHIMA CIC or CCS or AAPC CPC
  • CCDS certification strongly preferred
  • Active and unrestricted RN or LPN license strongly preferred

Experience/Qualifications:

  • Extensive knowledge of medical terminology, anatomy and coding guidelines for ICD-10-CM and ICD-10-PCS
  • At least 3 years of recent DRG Validation experience
  • Strong knowledge of MS-DRG, APR-DRG, and payer-specific grouping logic.
  • Proficient in compliant query practices
  • Knowledge of current and developing issues, trends in medical coding procedures requirements, and be able to research as needed
  • Knowledge of legal, regulatory, and policy compliance issues related to medical coding and billing procedures, and documentation including CMS guidelines
  • Ability to interpret complex medical documentation accurately
  • Proficient computer skills using MS-Word, Excel, Outlook, Internet Explorer, electronic medical records (EMR) systems including Epic, Meditech, Cerner, etc. along with 3M computer assisted coding program.
  • Meet required client productivity standards and maintain minimum of 97% accuracy
  • Self-sufficient with strong analytical and research skills
  • Responsible and responsive
  • Strong attention to detail
  • Excellent written and oral communication skills
  • Ability to meet deadlines
  • Must reside and be legal to work in the U.S

Job Type: Part-time

Pay: $39.00 - $41.00 per hour

Expected hours: No more than 20 per week

Benefits:

  • 401(k)
  • Paid time off
  • Professional development assistance

Experience:

  • recent DRG Validation: 3 years (Required)

License/Certification:

  • and unrestriced RN or LPN license (Preferred)
  • AHIMA CIC or CCS or an AAPC CPC credential (Required)

Work Location: Remote

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