DRG Validation Specialist
2 weeks ago
DRG Validation Specialist We are seeking a knowledgeable and detail-driven DRG Validation Specialist to ensure accuracy and compliance in diagnosis-related group (DRG) assignment and inpatient medical record coding. This role plays a key part in supporting revenue integrity, reducing audit risk, and ensuring accurate representation of patient acuity and clinical documentation. Key Responsibilities Perform comprehensive DRG validation reviews on inpatient medical records to ensure accurate code assignment, clinical justification, and regulatory compliance. Validate ICD-10-CM, ICD-10-PCS, and sequencing accuracy to support compliant DRG assignment and reimbursement. Identify and address discrepancies related to clinical documentation, coding, and DRG grouping; initiate clarification queries when necessary. Analyze clinical indicators and documentation to ensure support for complications/co-morbidities (CCs/MCCs) and medical necessity. Collaborate with Coding, CDI, and Revenue Cycle teams to resolve variances and ensure alignment with documentation and reporting requirements. Participate in internal and external audit processes and support appeals for denied or challenged DRG assignments. Maintain required productivity benchmarks and exceed accuracy quality metrics (typically ≥95%). Stay current with changes in coding guidelines, DRG methodology, payer rules, and regulatory updates. Participate in training, education, special projects, and process improvement initiatives. Qualifications Required certification: CCS, RHIT, RHIA, or CPC with inpatient coding experience. Minimum experience: 3+ years inpatient coding experience; DRG validation or audit experience strongly preferred. Strong working knowledge of: ICD-10-CM/PCS coding DRG payment methodologies (MS-DRG, APR-DRG, etc.) CMS and payer-specific audit criteria Prior experience with CDI programs, audit software, or EMR/EHR systems preferred. Skills & Competencies Exceptional accuracy and attention to detail Strong critical thinking and clinical interpretation skills Ability to interpret complex documentation and clinical terminology Effective communication and collaboration across departments Strong organizational and time-management abilities
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DRG Reviewer
6 days ago
Nashville, United States The Rawlings Group Full timeJob DetailsDescription Who We Are Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 60 health plans, including many of the top 20, and representing more than 160 million lives, Machinify brings...
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DRG Validation Auditor
4 days ago
Nashville, United States HCA Full timeDescription Introduction Are you passionate about the patient experience? At HCA Healthcare, we are committed to caring for patients with purpose and integrity. We care like family! Jump-start your career as a DRG Validation Auditor today with Parallon. Benefits Parallon offers a total rewards package that supports the health, life, career and retirement of...
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DRG Onsite Reviewer
3 weeks ago
Nashville, United States Refactor Talent Full timeAbout the role Were seeking to connect an DRG Reviewer with a leading healthcare company in Nashville, TN, on a full-time basis. This role is in person. As a DRG Reviewer, you will be responsible for providing MS-DRG and APR-DRG audit services at provider locations, ensuring accurate reimbursement and compliance. Base pay range $85,000.00/yr - $105,000.00/yr...
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DRG Onsite Reviewer
2 weeks ago
Nashville, United States Refactor Talent Full timeAbout the role Were seeking to connect an DRG Reviewer with a leading healthcare company in Nashville, TN, on a full-time basis. This role is in person. As a DRG Reviewer, you will be responsible for providing MS-DRG and APR-DRG audit services at provider locations, ensuring accurate reimbursement and compliance. Base pay range $85,000.00/yr - $105,000.00/yr...
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DRG Validation Auditor
4 days ago
Nashville, Tennessee, United States Parallon Full timeIntroductionAre you passionate about the patient experience? At HCA Healthcare, we are committed to caring for patients with purpose and integrity. We care like family Jump-start your career as a DRG Validation Auditor today with Parallon.BenefitsParallon offers a total rewards package that supports the health, life, career and retirement of our colleagues....
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Inpatient Coding Denials Specialist
1 week ago
Nashville, United States HHS, LLC Full timePosition OverviewWe are seeking an experienced Inpatient Coding Denials Specialist to review and resolve inpatient coding-related denials and prevent lost reimbursement. The ideal candidate has strong inpatient coding expertise, DRG assignment experience, and the ability to write effective clinical/coding appeals.In this role, you will review medical...
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Inpatient Coding Denials Specialist
3 weeks ago
Nashville, United States HHS, LLC Full timePosition OverviewWe are seeking an experienced Inpatient Coding Denials Specialist to review and resolve inpatient coding-related denials and prevent lost reimbursement. The ideal candidate has strong inpatient coding expertise, DRG assignment experience, and the ability to write effective clinical/coding appeals.In this role, you will review medical...
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Coding Quality Review Specialist
2 days ago
Nashville, United States Cooperidge Consulting Firm Full timeCooperidge Consulting Firm is seeking a Coding Quality Review Specialist for a top healthcare client based in Nashville, TN (remote position).The CQR Specialist performs internal quality assessments of coding accuracy and compliance across inpatient and outpatient records. This role ensures adherence to national coding standards, HSC policies, and company...
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Coding Quality Review Specialist
1 week ago
Nashville, Tennessee, United States Cooperidge Consulting Firm Full time $60,000 - $120,000 per yearCooperidge Consulting Firm is seeking a Coding Quality Review Specialist for a top healthcare client based in Nashville, TN (remote position).The CQR Specialist performs internal quality assessments of coding accuracy and compliance across inpatient and outpatient records. This role ensures adherence to national coding standards, HSC policies, and company...
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CDI Reconciliation Specialist
5 days ago
Nashville, United States HCA Full timeDescription This is a fully remote role, but you must live within 60 miles of an HCA facility Introduction Do you want to join an organization that invests in you as a CDI Reconciliation Specialist? At HCA Healthcare, you come first. HCA Healthcare has committed up to 300 million in programs to support our incredible team members over the course of three...
