Job Title: RN DRG Coding Validator / Auditor
Location: Remote / Virtual (U.S. Based)
Position Type: Full-Time, Direct Hire
Salary Range: $90,000 - $120,000 / year (Dependent on experience)
Job Summary Are you a Registered Nurse with a passion for data integrity, clinical accuracy, and medical coding? We are seeking a dual-expert
RN DRG Coding Validator to join our small, innovative clinical team. This role integrates advanced clinical nursing knowledge with expert inpatient coding proficiency to perform comprehensive post-payment validation of Diagnosis-Related Group (DRG) assignments and associated inpatient medical record coding.
In this role, you will evaluate both the clinical validity of documented diagnoses and the accuracy of ICD-10-CM/PCS code assignments, DRG sequencing, and discharge dispositions. Serving insurance payers, you will identify coding inaccuracies, unsupported clinical documentation, and DRG assignment errors across MS-DRG and APR-DRG methodologies to help pinpoint overpayments.
Primary Duties & Responsibilities - Clinical Chart Review: Review inpatient medical records in their entirety (H&Ps, progress notes, operative reports, discharge summaries) to evaluate clinical support for reported diagnoses and procedures.
- Clinical Validation: Apply nursing expertise to assess whether documented conditions meet established clinical criteria (e.g., Sepsis-3, SIRS, HAC definitions) sufficient to support code assignment, including CC and MCC designations.
- Coding Validation: Validate ICD-10-CM principal and secondary diagnosis codes, ICD-10-PCS procedure codes, sequencing, present-on-admission (POA) indicators, and discharge disposition in accordance with CMS Official Guidelines.
- Audit Determination: Evaluate MS-DRG and APR-DRG assignment accuracy, identifying opportunities for upgrades and downgrades based on documented clinical evidence.
- Write Rationales: Produce clear, accurate, and concise written rationales for all validation findings, citing applicable Official Coding Guidelines, Coding Clinic references, and clinical criteria.
- Maintain Production Metrics: Manage a daily workload of approximately 15 to 20 case reviews. Note: Case review efficiency is highly accelerated due to our cutting-edge internal AI record-summarization tool.
Required Qualifications - Licensure: Active Registered Nurse (RN) license in the United States (compact or state-specific accepted and in good standing).
- Coding Certification: Certified Inpatient Coder (CIC) or Coding and Classification Specialist (CCS) issued by AHIMA or AAPC (current and in good standing).
- Clinical Experience: Minimum of 5 years of acute care inpatient hospital experience.
- Specialized Experience: At least 3 years in a dedicated inpatient coding, DRG validation, or Clinical Documentation Improvement (CDI) role.
- Methodology Expertise: 2+ years of dedicated experience working with APR-DRG reimbursement methodologies, Severity of Illness (SOI), and Risk of Mortality (ROM) levels.
- Technical Proficiency: Demonstrated mastery of ICD-10-CM/PCS code assignment, MS-DRG methodologies, and CMS Official Guidelines for Coding and Reporting.
Preferred Skills - Experience utilizing Encoder Software (e.g., 3M, Optum360, Nuance).
- Comfortable leveraging and utilizing AI technology tools to optimize daily workflow and increase productivity.
- Ability to work highly independently and maintain personal accountability in a remote environment.
Schedule & Shift Flexibility - Standard 40-hour work week.
- Flexible Scheduling: Enjoy flexible scheduling options once you are fully ramped up. The majority of our current team elects to work a 4x10 schedule (four 10-hour days) for an extended weekend!
Why You'll Love Working Here (Benefits & Perks) We believe our team deserves the best, which is why we offer an industry-leading compensation and rewards package that starts on day one:
- Financial Incentives: Eligible after your first 90 days for a monthly performance bonus based on revenue returned to clients (typically ranging between $1,000-$1,500/month).
- Health & Wellness: Medical, dental, and vision insurance coverage beginning on your very first day. Plus, company-paid access to virtual counseling and telemedicine.
- Retirement & Security: 401(k) with company match and immediate vesting, alongside company-paid Short-Term Disability (STD).
- Work From Home Setup: A one-time home office supply stipend to customize your workstation (company laptop and charging cables provided).
- Work-Life Balance: Generous time off including 4 weeks of vacation accrual starting day one, 1 additional dedicated week for wellness, 9 paid company holidays, and 2 floating holidays.
- Family Support: Paid Parental Leave to focus on your family during life's special chapters.
- Extra Perks: Company-paid personal financial advising, choice of two carrier options for pet insurance, and a $500 annual professional development stipend after your first year to invest in your continuous growth.
