DRG Validator/Reviewer

Job not on LinkedIn

🔥 2 hours ago

🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

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EnableComp

WebsiteLinkedInAll Job Openings

501 - 1000 employees

💼 Consulting

🛡️ Insurance

📦 Logistics

💰 Venture Round on 2022-07

Consulting • Insurance • Logistics

EnableComp is a company that specializes in revenue cycle management (RCM) for healthcare providers and health systems across the United States. They focus on processing complex claims related to Veterans Administration, Workers' Compensation, Motor Vehicle Accidents, and Out-of-State Medicaid, as well as denial management for all payer classes. By leveraging intelligent automation and their proprietary E360 RCM™ platform, EnableComp helps healthcare providers increase revenue, control costs, and streamline billing processes. With expertise in handling complex claims, the company ensures accurate and timely reimbursement, providing significant uplift to collections and improving the financial performance of its clients.

📋 Description

• Review inpatient claims imported into the DRG database, focusing on diagnosis, procedures, grouping logic, and reimbursement accuracy. • Analyze weekly hospital billing files, identifying underpaid claims based on ICD-10 diagnosis and procedure codes. • Conduct detailed medical record reviews post-bill to determine if submitted diagnosis and procedure codes are accurate and complete. • Navigate medical records efficiently, targeting specific sections (e.g., discharge summary, operative reports) based on system edits and flagged items. • Match clinical documentation in the medical record to corresponding ICD-10 codes, ensuring DRG accuracy. • Identify and correct errors such as under coded or misclassified diagnoses and procedures. • Utilize Health ROI system edits to detect specific high-value opportunities (e.g., dialysis, occlusion, embolization, catheterization). • Make reimbursement improvement recommendations and submit findings for client review and approval. • Collaborate with leadership on case prioritization and workflow management. • Stay informed on coding updates, payer guidelines, and DRG changes to support accurate recommendations. • Analyze client reporting. • Identify new revenue opportunities related to all inpatient DRG related components.

🎯 Requirements

• Associate's or bachelor’s degree in health information management or related field required. (RHIT or RHIA credentialed individuals encouraged). • Certified Coding Specialist (CCS) certification required. • 2-3 years’ experience in DRG validation, inpatient medical coding, or related coding review. • Strong understanding of ICD-10-CM/PCS coding guidelines, DRG reimbursement methodology, and hospital billing processes. • Proficient in reading and interpreting clinical documentation across multiple departments (e.g., nursing, operative, radiology, pharmacy). • Experience working in a post-bill coding environment and familiarity with DRG grouping software and billing databases. • Analytical thinker with a focus on financial impact and reimbursement accuracy. • Comfortable navigating multiple digital platforms, EMRs, and data systems. • Must have strong computer proficiency and understand how to use basic office applications, including MS Office (Word, Excel, and Outlook).

🏖️ Benefits

• EnableComp is an Equal Opportunity Employer M/F/D/V. • We are committed to creating and maintaining a workforce environment that is free from any form of discrimination or harassment. • Continuous commitment to professional growth and development of our people. • Investing in our employees is the key to our success.