DRG Validator

DRG Validator

Job Summary : The DRG Validator will be responsible for coding reviews for the purpose of coding and DRG optimization. Must have thorough knowledge of medical terminology, ICD codes and coding guidelines. Strong oral and written communications skills is required and be proficient in working with multiple computer applications and EMR systems.

Responsibilities :

• Review diagnostic, procedural and DRG assignments for validity and accuracy.
• Communication discrepancies back to responsible coder for correction.
• Educates coders on regulatory changes, trends form chart reviews, problemtic areas, high-risk and other problems identified during reviews.
• Provides education to medical staff as necessary.
• Contacts physicians or departmental clinical staff to resolve discrepancies or clarify information.
• Queries physicians for clarification of documentation, if necessary.
• Abstracts information from medical records to compile reports and statistical information.
• Enters data, including diagnosis, procedures, admission, and discharge dates.
• Validates discharge disposition.
• Provides information to HIM management staff to assist in preparation of monthly reports of coder discrenpecies.
• Keeps abreast of regulatory changes affecting coding.
• Reviews denials from insurance companies and drafts appeals.

Qualifications / Requirements :

Experience : Minimum of 2-3 years related experience in acute car environment; must be proficient with multiple EMR systems, 3M Encoder and have a minimum of 5 years’ experience specializing in inpatient.

Education : Bachelor’s degree in a health related field, required. Or the equivalent combination of Experience and Education maybe substituted for degree requirement

Licenses / Certifications : AHIMA, RHIT OR (CCS) credential, required.

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