Opportunity Description
Job Description
The DRG Validation position requires an extensive background in inpatient DRG coding with a deep
understanding of the MS-DRG and APR-DRG payment systems. The validator is responsible for
auditing inpatient medical records, ensuring the accuracy of coding, provider documentation, and DRG
assignment.
Key Responsibilities
• Perform concurrent and retrospective clinically based and MS-DRG and APR DRG validation
reviews in compliance with appropriate coding and payments adhering to Uniform Hospital
Discharge Date Set (UHDDS) and Medicare guidelines including Federal and State regulations.
• Review the correct assignment of ICD-10-CM diagnosis & ICD-10-PCS procedure codes.
• Effectively utilize facility Encoders, EMRs, abstracting systems (3M, EPIC, etc.) and auditing tools
and systems (e.g., TruCode, 3M Standalone, etc.) proficiently to make audit determinations.
• Write clear, accurate, and concise rationales supporting audit findings.
The DRG Validation position requires an extensive background in inpatient DRG coding with a deep
understanding of the MS-DRG and APR-DRG payment systems. The validator is responsible for
auditing inpatient medical records, ensuring the accuracy of coding, provider documentation, and DRG
assignment.
Key Responsibilities
• Perform concurrent and retrospective clinically based and MS-DRG and APR DRG validation
reviews in compliance with appropriate coding and payments adhering to Uniform Hospital
Discharge Date Set (UHDDS) and Medicare guidelines including Federal and State regulations.
• Review the correct assignment of ICD-10-CM diagnosis & ICD-10-PCS procedure codes.
• Effectively utilize facility Encoders, EMRs, abstracting systems (3M, EPIC, etc.) and auditing tools
and systems (e.g., TruCode, 3M Standalone, etc.) proficiently to make audit determinations.
• Write clear, accurate, and concise rationales supporting audit findings.
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