DRG Validator/Reviewer

EnableComp

DRG Validator/Reviewer responsible for reviewing post-billed inpatient claims for missed reimbursement opportunities. Utilizes ICD-10 coding expertise to optimize hospital reimbursement while ensuring compliance.

Posted 7/28/2026full-timeRemote • Tennessee • 🇺🇸 United StatesJuniorMid-LevelWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in inpatient medical coding, specifically in DRG validation and ICD-10 coding, while ensuring reimbursement accuracy and compliance with hospital billing processes. Proficient in analyzing clinical documentation and identifying revenue opportunities to enhance financial outcomes.

Highest-signal resume keywords

ICD-10-CM/PCS Coding GuidelinesDRG Reimbursement MethodologyCertified Coding Specialist (CCS)Inpatient Medical Coding ExperienceHealth Information Management Degree

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

DRG ValidationMedical Record ReviewReimbursement AnalysisCoding Accuracy AssessmentError Identification and Correction

Soft Skills

Analytical ThinkingCollaboration with LeadershipAttention to Detail

Tools & Technologies

Health ROI SystemDRG Grouping SoftwareElectronic Medical Records (EMR)MS Office (Word, Excel, Outlook)

Certifications & Qualifications

Certified Coding Specialist (CCS)RHIT or RHIA Credential

Industry Keywords

Inpatient ClaimsHospital Billing ProcessesClinical DocumentationRevenue OpportunitiesPayer Guidelines

About the role

Key responsibilities & impact

Review inpatient claims imported into the DRG database, focusing on diagnosis, procedures, grouping logic, and reimbursement accuracy.
Analyze weekly hospital billing files, identifying underpaid claims based on ICD-10 diagnosis and procedure codes.
Conduct detailed medical record reviews post-bill to determine if submitted diagnosis and procedure codes are accurate and complete.
Navigate medical records efficiently, targeting specific sections (e.g., discharge summary, operative reports) based on system edits and flagged items.
Match clinical documentation in the medical record to corresponding ICD-10 codes, ensuring DRG accuracy.
Identify and correct errors such as under coded or misclassified diagnoses and procedures.
Utilize Health ROI system edits to detect specific high-value opportunities (e.g., dialysis, occlusion, embolization, catheterization).
Make reimbursement improvement recommendations and submit findings for client review and approval.
Collaborate with leadership on case prioritization and workflow management.
Stay informed on coding updates, payer guidelines, and DRG changes to support accurate recommendations.
Analyze client reporting.
Identify new revenue opportunities related to all inpatient DRG related components.

Requirements

What you’ll need

Associate's or bachelor’s degree in health information management or related field required. (RHIT or RHIA credentialed individuals encouraged).
Certified Coding Specialist (CCS) certification required.
2-3 years’ experience in DRG validation, inpatient medical coding, or related coding review.
Strong understanding of ICD-10-CM/PCS coding guidelines, DRG reimbursement methodology, and hospital billing processes.
Proficient in reading and interpreting clinical documentation across multiple departments (e.g., nursing, operative, radiology, pharmacy).
Experience working in a post-bill coding environment and familiarity with DRG grouping software and billing databases.
Analytical thinker with a focus on financial impact and reimbursement accuracy.
Comfortable navigating multiple digital platforms, EMRs, and data systems.
Must have strong computer proficiency and understand how to use basic office applications, including MS Office (Word, Excel, and Outlook).

Benefits

Comp & perks

EnableComp is an Equal Opportunity Employer M/F/D/V.
We are committed to creating and maintaining a workforce environment that is free from any form of discrimination or harassment.
Continuous commitment to professional growth and development of our people.
Investing in our employees is the key to our success.