Will McDonald

This position would require an onsite interview, and onsite potentially during onboarding and a few visits per year (costs covered). It is a beautiful coastal location that would be FUN to visit!

Job Summary:

The CPC - DRG Validator ensures accurate assignment of Diagnosis Related Groups (DRGs) by applying expertise in medical coding, clinical documentation, and reimbursement principles. This role promotes a culture of safety, service excellence, and compliance with all regulatory requirements.

Key Responsibilities

• Review medical records to validate accurate DRG assignments, ensuring correct case mix and compliance with federal and healthcare policies.
• Analyze patient charts for discrepancies or inconsistencies in coding or documentation.
• Collaborate with coding and clinical staff to resolve coding-related issues and participate in audits and quality improvement initiatives.
• Conduct second reviews of focus DRGs, discharge dispositions, and Present on Admission (POA) flags prior to billing.
• Communicate coding changes and clarifications to ancillary departments and medical staff, supporting education and quality improvement.
• Assist in regulatory audits, recovery audit activities, and maintenance of audit software.
• Research and respond to documentation and code assignment denials, coordinating with payers on DRG mismatches.
• Develop and conduct educational sessions for coding and medical staff on documentation improvement and coding standards.
• Create and refine coding queries in line with AHMIA physician query guidelines.

Qualifications

Education:

• College degree in Health Information Management or a related field.

Experience:

• At least 5 years of inpatient coding experience.

Licensure/Certification:

• Credentialed coding professional required (RHIA, RHIT, CCS, CPC, or CCS-P).

Skills:

• In-depth knowledge of coding guidelines, DRG assignment, UB-04 standards, and regulatory requirements.
• Proficiency in medical record analysis and audit processes.
• Strong communication and education skills to support documentation improvement initiatives