DRG Validator

Smith Arnold Partners

Our client, an academic acute care center, is looking for a DRG Validator to join their growing HIM department. The DRG Validator is responsible for performing quality reviews on medical records to validate ICD-10 CM and PCS Codes, DRG appropriateness and missed secondary diagnoses and procedures. The DRG Validator ensures compliance and accuracy of the MS-DRG and APR DRG.

Title: DRG Validator
Location: Tarrytown, NY
Salary: $110,000


-Evaluates quality of clinical documentation to identify incomplete or inconsistent documentation for inpatient encounters that impact the code selection and resulting DRG groups and payment
-Communicates with attending physician either verbally or through written methodology to validate observations and suggests additional or more specific documentation, as it relates to, coding compliance, medical necessity and documentation improvement.
-Provides feedback to HIM management staff and CDI leadership regarding opportunities for documentation improvements
-Plans and develops educational programs directed towards improving documentation
-Assists in the review and distribution of coding related information to clinical staff, coders including ICD-10-CM & PCS coding changes, medical necessity policies and coding/billing information regarding new procedures and devices

-Must have a CCS
-Need a minimum of 2 years DRG Validation experience from an acute care hospital
-Strong knowledge of ICD-10-CM coding
-Excellent knowledge of federal and All-Payer DRG reimbursement methodology