DRG Inpatient Coding Validator

Accountabilities: Review inpatient claims prospectively and retrospectively to identify DRG-related coding and payment inaccuracies. Identify potential overpayments, including cases involving possible upcoding, and support appropriate recovery efforts. Assess clinical documentation and coding practices to validate the accuracy of billed procedures and DRG assignments. Collaborate with clinical, claims, and payment integrity teams to investigate and resolve coding concerns. Participate in discussions with physicians and medical professionals to understand and verify the clinical rationale behind billed procedures. Communicate findings clearly to internal stakeholders and external providers to support accurate claims adjudication and appropriate provider notification. Apply quality assurance standards and regulatory requirements consistently throughout the clinical review process. Build effective working relationships across multidisciplinary teams and contribute to the continuous improvement of review workflows. Requirements: Active Certified Coding Specialist (CCS) or Certified Inpatient Coder (CIC) certification is required. At least 1 year of direct inpatient clinical coding experience. Working knowledge of Diagnosis-Related Group (DRG) pricing methodology is required. Understanding of inpatient medical records, clinical coding practices, and DRG validation processes. Strong analytical skills and attention to detail when reviewing clinical documentation and claims. Proficiency with computer applications, particularly Microsoft Excel and PowerPoint. Effective written and verbal communication skills, with the ability to collaborate across clinical and operational teams. Ability to manage review workflows independently while maintaining accuracy and regulatory compliance. Experience in Medicare or Medicare Advantage payment integrity or claims operations is preferred. Benefits: Base salary: $76,000–$99,000 USD, with final compensation determined by factors such as experience, education, certifications, and internal equity. Equity opportunities and a performance-based bonus program. 401(k) matching and regular compensation reviews. Comprehensive medical, dental, and vision coverage. Flexible paid time off and monthly company holidays. No-Meeting Fridays and access to mental health resources. Paid parental leave for all new parents. Employee Stock Purchase Plan (ESPP) with discounted equity opportunities. Reimbursement for office setup expenses. Monthly cell phone and internet stipend. Learning programs, mentorship, professional development funding, and regular performance feedback. Remote-first working environment.