Inpatient DRG Validator (Acute Care)
Core
Auditing inpatient medical records and generating high-quality recoverable claims for acute care hospitals and clients.
Role type
Senior IC medical claims auditor (DRG validation)
Builds
Recoverable claims and audit findings letters for acute care lines of business
Domain
Healthcare administration and medical billing
Required skills
ICD-10 coding, MS-DRG/AP-DRG/APR-DRG expertise, clinical guidelines, audit tools, medical record review, claim type identification
Preferred skills
Vendor-based DRG coding experience, medical claims billing systems knowledge, payer reimbursement policies, 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; Suggest process improvement and efficiency recommendations
Seniority
Senior, hands-on IC
