As a key member of Secondwave's Inpatient documentation review team, the Diagnostic Related Group (DRG) DRG Validation Auditor partners with a Medical Director (Physician) in tandem to ensure accurate and compliant DRG assignment through secondary review of inpatient medical records. This role involves validating diagnosis and procedure codes and updating coding as needed in alignment with federal regulations, official coding guidelines, and client-specific standards which result in appropriate reimbursement and data integrity. The position requires strong analytical skills, deep knowledge of DRG methodologies, and a commitment to supporting appropriate reimbursement and data integrity.
Primary Responsibilities - Conduct detailed pre-bill reviews in collaboration with physicians to confirm accurate diagnosis and procedure coding for inpatient encounters
- Utilize proprietary technology and client systems to track coding changes, identify query opportunities, and capture audit data
- Investigate and resolve coding compliance issues, inappropriate coding, and client denials
- Maintain high accuracy and productivity standards while meeting organizational coding recommendations
- Communicate effectively with physicians, CDI specialists, and internal teams regarding documentation and compliance requirements
- Provide input on process improvements to enhance operational efficiency and financial accuracy
- Develop and adapt client-specific protocols to align with organizational methodology
- Deliver group education and training sessions on coding best practices and regulatory updates
- Participate in ongoing training to stay current with coding changes and compliance regulations
- Ensure confidentiality of patient records and adhere to HIPAA standards
- Perform additional coding tasks as needed based on organizational priorities
Position Qualifications - Education:
- High School Diploma or GED required
- Associate's degree in Health Information Management or related field preferred
- Experience:
- Minimum 3 years of inpatient hospital coding experience
- Minimum 2 years in a role involving DRG validation and compliance review
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- Strong knowledge of MS-DRG and APR-DRG reimbursement methodologies
- Credentials:
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- Active coding certification from AHIMA or AAPC (RHIA, RHIT, CCS, CPC, CIC)
- Knowledge, Skills, and Abilities:
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- Expert understanding of ICD-10-CM/PCS coding guidelines and auditing principles
- Ability to interpret complex documentation and apply compliant coding updates
- Advanced proficiency in EMR systems and coding software; EPIC experience preferred
- Strong analytical and critical thinking skills for problem-solving and compliance review
- Excellent communication and interpersonal skills for collaboration with physicians and CDI teams
- Knowledge of regulatory requirements and policy compliance related to coding and documentation
- Ability to maintain confidentiality and exercise independent judgment
- Proficiency in Microsoft Office Suite (Word, Excel, Teams)
- Self-directed and adaptable to remote or on-site work environments
Job Benefits - Health insurance
- Vision insurance
- Dental insurance
- Life insurance
- Retirement plan
- Paid time off
Location Compensation Range: $85,000 - $110,000
