DRG Validation Specialist
Job Description
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DRG Validation Specialist
We are seeking a knowledgeable and detail-driven DRG Validation Specialist to ensure accuracy and compliance in diagnosis-related group (DRG) assignment and inpatient medical record coding. This role plays a key part in supporting revenue integrity, reducing audit risk, and ensuring accurate representation of patient acuity and clinical documentation.
Key Responsibilities
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Perform comprehensive DRG validation reviews on inpatient medical records to ensure accurate code assignment, clinical justification, and regulatory compliance.
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Validate ICD-10-CM, ICD-10-PCS, and sequencing accuracy to support compliant DRG assignment and reimbursement.
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Identify and address discrepancies related to clinical documentation, coding, and DRG grouping; initiate clarification queries when necessary.
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Analyze clinical indicators and documentation to ensure support for complications/co-morbidities (CCs/MCCs) and medical necessity.
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Collaborate with Coding, CDI, and Revenue Cycle teams to resolve variances and ensure alignment with documentation and reporting requirements.
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Participate in internal and external audit processes and support appeals for denied or challenged DRG assignments.
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Maintain required productivity benchmarks and exceed accuracy quality metrics (typically ≥95%).
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Stay current with changes in coding guidelines, DRG methodology, payer rules, and regulatory updates.
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Participate in training, education, special projects, and process improvement initiatives.
Qualifications
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Required certification: CCS, RHIT, RHIA, or CPC with inpatient coding experience.
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Minimum experience: 3+ years inpatient coding experience; DRG validation or audit experience strongly preferred.
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Strong working knowledge of:
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ICD-10-CM/PCS coding
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DRG payment methodologies (MS-DRG, APR-DRG, etc.)
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CMS and payer-specific audit criteria
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Prior experience with CDI programs, audit software, or EMR/EHR systems preferred.
Skills & Competencies
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Exceptional accuracy and attention to detail
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Strong critical thinking and clinical interpretation skills
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Ability to interpret complex documentation and clinical terminology
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Effective communication and collaboration across departments
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Strong organizational and time-management abilities
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Meet Your Recruiter
Jonathan Allon
Director of Operations
Jon Allon is from Los Angeles, CA originally and now calls San Diego home. He has a natural love for connecting with people, talking, learning, and creating relationships. He is a dedicated professional with a solid background in high-volume office environments, focused on delivering exceptional support for healthcare professionals. He is a personable and communicative individual with a friendly demeanor and sound judgment to handle diverse daily tasks with minimal oversight.
Jon is very excited to work with an industry leader like All Med Search who he believes has the same goals and values that are instilled in him: Quality, passion, strategic intent, persistent sourcing, service excellence and social responsibility. To Jon, success is setting a goal, committing to that goal, developing your skills to reach that goal, doing your very best and not stopping once the goal is reached.