DRG Validator/Reviewer (REMOTE)
- Role
- Finance
- Employment
- Full-time
Open to US only. Set where you work from to check your eligibility.
No BS summary
DRG inpatient claims reviewer with CCS certification and strong ICD-10 coding knowledge. Must understand medical record documentation, clinical coding guidelines, DRG reimbursement methodology, and PHI privacy/security.
Core skills
EnableComp provides Specialty Revenue Cycle Management solutions for healthcare organizations, leveraging over 24 years of industry-leading expertise and its unified E360 RCM™ intelligent automation platform to improve financial sustainability for hospitals, health systems, and ambulatory surgery centers (ASCs) nationwide. Powered by proprietary algorithms, iterative intelligence from 10M+ processed claims, and expert human-in-the-loop integration, EnableComp provides solutions across the revenue lifecycle for Veterans Administration, Workers’ Compensation, Motor Vehicle Accidents, and Out-of-State Medicaid claims as well as denials for all payer classes. By partnering with clients to supercharge the reimbursement process, EnableComp removes the burden of payment from patients and provider organizations while enabling accelerated cash, higher and more accurate yield, clean AR management, reduced denials, and data-rich performance management. EnableComp is a multi-year recipient the Top Workplaces award and was recognized as Black Book's #1 Specialty Revenue Cycle Management Solution provider in 2024 and is among the top one percent of companies to make the Inc. 5000 list of the fastest-growing private companies in the United States for the last eleven years.
Position Summary
The DRG Validator/Reviewer is responsible for reviewing post-billed inpatient claims to identify and validate missed reimbursement opportunities based on diagnosis and procedure coding. Working within a specialized DRG (Diagnosis-Related Group) database, DRG Reviewers utilize their technical expertise in ICD-10 coding to analyze medical records, determine coding accuracy, and make recommendations that optimize hospital reimbursement. This role requires certification as a Certified Coding Specialist (CCS) and a deep understanding of medical record documentation, clinical coding guidelines, and DRG reimbursement methodology. This position is responsible for handling patient health information (PHI) and maintaining extreme privacy and security as it relates to confidential and proprietary information.
What you'll do
- Reviewing post-billed inpatient claims to identify and validate missed reimbursement opportunities based on diagnosis and procedure coding.
- Working within a specialized DRG (Diagnosis-Related Group) database.
- Utilize technical expertise in ICD-10 coding to analyze medical records.
- Determine coding accuracy.
- Make recommendations that optimize hospital reimbursement.
- Handle patient health information (PHI).
- Maintain extreme privacy and security as it relates to confidential and proprietary information.
What they require
- Certification as a Certified Coding Specialist (CCS).
- Deep understanding of medical record documentation, clinical coding guidelines, and DRG reimbursement methodology.
- Experience and knowledge relevant to the position.
- Ability to handle patient health information (PHI) and maintain extreme privacy and security as it relates to confidential and proprietary information.
Benefits
- EnableComp recruits, develops and retains the industry's top talent.
- Continuous commitment to building and maintaining a culture centered around fostering the professional growth and development of our people.
- Tools, resources, and support employees need to thrive and grow their career here.
- Company values its employees and is dedicated to helping them achieve their full potential.
- Family oriented and flexible company culture.
- Understanding the balance of work, life, and fun.