Certified DRG Validation Specialist

Job Summary

A company is looking for a DRG Validation Specialist to conduct clinical audits and ensure the accuracy of DRG claims.

Key Responsibilities

• Conduct clinical audits including DRG validation and billing discrepancies
• Identify compliance risks and financial opportunities based on chart reviews
• Collaborate with internal teams and communicate findings to clients

Required Qualifications

• 3-5 years of auditing, claims review, or billing experience in a healthcare organization
• In-depth knowledge of ICD-10-CM/PCS, HCPCS/CPT, and DRG coding systems
• Experience in bill and concurrent review
• Active certification as a coder (RHIA, RHIT, CPC, CIC, COC, or CCS) required
• Working knowledge of Health Insurance and Medicare guidelines