DRG Validation Auditor [For Pooling]

Position Description:

The DRG Validation Auditor is responsible for reviewing medical records to determine the accuracy of coding and reimbursement for clinical services rendered to beneficiaries of health plans, including Commercial and Government Clients.

Your future duties and responsibilities:

 Reviews inpatient medical records to validate, assignment and sequencing of ICD-9-CM and ICD-10 diagnosis and procedure codes, discharge status codes, and DRG assignment.
 Provides a detailed rationale for every medical record review resulting in a DRG Review Results letter, including supporting references.
 Follows proper procedure for referral to Clinical Nurse Auditor or Physician Advisor, as applicable.
 Utilizes proper reference material, standards, and guidelines for coding.
 Provides input to the Edit Development team on claims selection criteria.
 Verifies data received from client and work to resolve discr...