Review post-billed inpatient claims in DRG database to identify missed reimbursement opportunities.
Analyze weekly hospital billing files to find underpaid claims based on ICD-10 codes.
Conduct medical record reviews to verify accuracy of submitted diagnoses/procedures.
Navigate medical records and target sections per system edits and flagged items.
Match clinical documentation to ICD-10 codes ensuring DRG accuracy.
Identify and correct under coded or misclassified diagnoses/procedures.

🎯 Requirements

Associate's or bachelor's in health information management or related field; RHIT/RHIA encouraged.
Certified Coding Specialist (CCS) certification required.
2-3 years in DRG validation, inpatient coding, or related coding review.
Strong understanding of ICD-10-CM/PCS, DRG reimbursement, and hospital billing.
Proficient in reading/interpreting clinical documentation across departments.
Experience in post-bill coding and DRG software/billing databases.

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