DRG Validator/DRG Auditor

We are currently looking for DRG Validator to be part of our DRG team

As a Inpatient DRG coder you'll determine if a discrepancy exists in the coding and clinical documentation using standard documentation guidelines applicable to the program.

Responsibilities include:

• Clinical validation of billed diagnoses that impact DRG
• Conduct initial audit reviews to validate billed diagnoses and DRG code are supported by medical records
• Record Audit results and document finding notes based on policies using professional clinical resources
• Perform provider appeals reviews and render decision to either uphold or overturn original finding
• Review questionable encoder results, complex cases, and appeal reviews to facilitate referrals to clinical department as needed
• Propose new audit concepts supported by your research and analysis.
• Define new audit concept criteria and test and validate new concepts developed by ana...