Inpatient DRG Validator (Acute Care)
Core
Auditing inpatient medical records and generating high-quality recoverable claims by evaluating coding and DRG assignment accuracy for acute care hospitals.
Role type
Inpatient DRG Validator (Clinical Coding & Audit)
Builds
Valid medical claims and audit findings letters for insurance payers
Domain
Healthcare administration / Medical billing and coding
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
ICD-10 coding expertise, MS-DRG/AP-DRG/APR-DRG knowledge, medical audit principles, clinical guidelines interpretation, audit tool utilization, documentation standards, claim type identification (re-admissions, Inpatient to Outpatient, HACs), process improvement recommendations
Preferred skills
Vendor-based DRG coding experience, hospital coding environment familiarity, medical claims billing system knowledge, payer reimbursement policy understanding, benefit program management
Technologies
ICD-9/10CM, MS-DRG, AP-DRG, APR-DRG, audit workflow systems
Responsibilities
Analyze and audit claims by integrating medical chart coding principles and clinical guidelines; Utilize audit tools to make determinations and generate audit findings letters; Identify new claim types such as re-admissions and Inpatient to Outpatient conversions; Suggest process improvement and efficiency recommendations
Seniority
Mid-level, specialized IC