DRG Inpatient Coding Validator
Core
Validate inpatient medical claims for DRG accuracy to prevent overpayments and ensure regulatory compliance.
Role type
Inpatient Clinical Coding Validator
Builds
Accurate claims adjudication and payment integrity workflows
Domain
Healthcare / Medical Billing & Claims
Required skills
DRG pricing methodology, Inpatient clinical coding, CCS or CIC certification, Medical records review, Claims processing, Regulatory policy knowledge
Preferred skills
Medicare/Medicare Advantage payment integrity experience, Excel, PowerPoint
Technologies
Excel, PowerPoint
Responsibilities
Review claims for DRG related issues on prospective and retrospective basis, Identify provider DRG denials and upcoding, Verify clinical rationale behind billed procedures with MDs, Communicate findings to ensure accurate claims adjudication and proper provider notification
Seniority
Individual Contributor, Entry to Mid-level
