About this position
Job Description
Job Description
As a key member of Secondwave’s Inpatient documentation review team, the Diagnostic Related Group (DRG) DRG Validation Auditor partners with a Medical Director (Physician) in tandem to ensure accurate and compliant DRG assignment through secondary review of inpatient medical records. This role involves validating diagnosis and procedure codes and updating coding as needed in alignment with federal regulations, official coding guidelines, and client-specific standards which result in appropriate reimbursement and data integrity. The position requires strong analytical skills, deep knowledge of DRG methodologies, and a commitment to supporting appropriate reimbursement and data integrity.
Primary Responsibilities
Conduct detailed pre-bill reviews in collaboration with physicians to confirm accurate diagnosis and procedure coding for inpatient encounters
Utilize proprietary technology and client systems to track coding changes, identify query opportunities, and capture audit data
Investigate and resolve coding compliance issues, inappropriate coding, and client denials
Maintain high accuracy and productivity standards while meeting organizational coding recommendations
Communicate effectively with physicians, CDI specialists, and internal teams regarding documentation and compliance requirements
Provide input on process improvements to enhance operational efficiency and financial accuracy
Develop and adapt client-specific protocols to align with organizational methodology
Deliver group education and training sessions on coding best practices and regulatory updates
Participate in ongoing training to stay current with coding changes and compliance regulations
Ensure confidentiality of patient records and adhere to HIPAA standards
Perform additional coding tasks as needed based on organizational priorities
Position Qualifications
Education:
High School Diploma or GED required
Associate’s degree in Health Information Management or related field preferred
Experience:
Minimum 3 years of inpatient hospital coding experience
Minimum 2 years in a role involving DRG validation and compliance review
Strong knowledge of MS-DRG and APR-DRG reimbursement methodologies
Credentials:
Active coding certification from AHIMA or AAPC (RHIA, RHIT, CCS, CPC, CIC)
Knowledge, Skills, and Abilities:
Expert understanding of ICD-10-CM/PCS coding guidelines and auditing principles
Ability to interpret complex documentation and apply compliant coding updates
Advanced proficiency in EMR systems and coding software; EPIC experience preferred
Strong analytical and critical thinking skills for problem-solving and compliance review
Excellent communication and interpersonal skills for collaboration with physicians and CDI teams
Knowledge of regulatory requirements and policy compliance related to coding and documentation
Ability to maintain confidentiality and exercise independent judgment
Proficiency in Microsoft Office Suite (Word, Excel, Teams)
Self-directed and adaptable to remote or on-site work environments
Job Benefits
- Health insurance
- Vision insurance
- Dental insurance
- Life insurance
- Retirement plan
- Paid time off
Location
- Remote
Compensation Range: $85,000 - $110,000
Location and commute
8350 W Cheyenne Ave, Las Vegas, NV 89129.
Plan your route with Google Maps. Travel times and transportation options vary; confirm the work location with the employer before commuting.
How to apply
Review the vacancy and complete the application on the employer or recruitment partner’s website. Requisition ID: WJ-3099891368.