Certified Coding Specialist (CCS) - job 1 of 3

Job Summary

A company is looking for a DRG Validator/Reviewer responsible for reviewing post-billed inpatient claims to identify and validate missed reimbursement opportunities.

Key Responsibilities

• Review inpatient claims in the DRG database for accuracy in diagnosis, procedures, and reimbursement
• Analyze hospital billing files to identify underpaid claims based on ICD-10 codes
• Conduct medical record reviews to ensure accuracy and completeness of submitted codes

Requirements and Qualifications

• Associate's or bachelor's degree in health information management or related field required
• Certified Coding Specialist (CCS) certification required
• 2-3 years' experience in DRG validation or inpatient medical coding
• Strong understanding of ICD-10-CM/PCS coding guidelines and DRG reimbursement methodology
• Experience in a post-bill coding environment and familiarity with DRG grouping software