DRG Validator-Diagnosis Related Groups-Remote
$23/29/34.98/hr.
Goals 4/hr. so around 28-32/day to review charts
Summary: The DRG Validator ensures the accurate assignment of Diagnosis Related Groups (DRGs) for our patients
and applies a thorough understanding of medical coding guidelines, clinical documentation, and reimbursement
principles.. All team members of Southeast Georgia Health System will promote a culture of safety, follow established
policies, and adhere to all state and federal regulatory requirements, Joint Commission requirements, and national patient
safety standards.
Service Excellence: All team members of Southeast Georgia Health System will promote service excellence by
developing and maintaining positive relationships with customers, other team members, and the medical staff and will
ensure the highest quality of care by performing their responsibilities according to the highest professional standards.
Reports To: Manager, Operations and Coding
Titles Supervised: None
Essential Responsibilities: This description of job responsibilities is intended to reflect the major responsibilities and duties of the job, but is
not intended to describe minor duties or other responsibilities as may be assigned from time to time.
1. Reviews medical records and clinical documentation to verify the accuracy of assigned DRGs to ensure the correct
case mix is reflected for our Health System. Analyzes patient charts to identify discrepancies or inconsistencies in
DRG assignment. Stays updated on changes in coding guidelines, regulations, and healthcare policies affecting
DRG assignment
2. Demonstrates understanding of policies, procedures and federal guidelines that apply directly to coding, DRG
assignment, reimbursement, clinical documentation improvement, and UB 04 standards. Responsible for reviewing
clinical documentation reviews performed for all inpatients prior to billing within the requirements of the Centers
of Medicaid & Medicare Services and other regulatory agencies
3. Collaborates with coding and clinical staff to resolve coding-related issues. Participates in coding audits and quality
improvement initiatives.
4. Effectively communicates current and revised coding changes and clarifications to ancillary departments and
Medical Staff members. Works with Quality team as needed
5. Performs second review of focus DRG’s, discharge disposition, and Present on Admission flags of encounters prior
to billing.
6. Performs additional audits for regulatory agencies as scheduled as part of fiscal responsibility to the health system.
7. Assists with coordinating educational sessions for the coding staff and medical staff regarding regulatory agencies
standards. Develops education materials and conducts education sessions regarding documentation improvement
for coding team and Medical Staff members.
8. Assists with maintenance of recovery audit software program. Utilizing software data to track and trend auditors’
focus and volumes.
9. Responsible for reviewing clinical documentation reviews performed for selected inpatients prior to billing within
the requirements of the Centers of Medicaid & Medicare Services and other regulatory agencies.
10. Assists the Recovery Audit Team with coordination, maintenance, and education regarding RAC and other external
agencies activities.
11. Develops and assists coders with the development of coding queries within the guidelines of the AHMIA physician
query process.
12. Responsible for researching and responding to documentation and code assignment denials as assigned.
Communicates with payers regarding DRG mismatch
Minimum Qualifications:
Education College Degree in Health Information Management or related field
Experience 5 years’ Inpatient coding experience
Licensure Credentialed coding professional, RHIA, RHIT, CCS, CPC CCS-P required
Knowledge/Skills/Abilities Computer skills. Establish secure remote environment for assigned responsibilities
Age Competencies __X__ Not applicable to job function.