IPDRG Coder / DRG Validation Specialist

IPDRG Coding

• Review inpatient medical records and accurately assign ICD-10-CM, ICD-10-PCS, CPT, and DRG codes.
• Ensure coding accuracy and compliance with established coding guidelines, regulatory requirements, and payer standards.
• Review clinical documentation to identify appropriate coding opportunities.
• Ensure accurate capture of MCCs, CCs, diagnoses, and procedures.
• Meet defined quality, accuracy, and productivity targets.
• Identify documentation gaps and collaborate with physicians/clinical teams for appropriate clarification.
• Maintain up-to-date knowledge of ICD-10 coding guidelines and DRG methodologies.

DRG Validation

• Conduct detailed DRG validation reviews of inpatient medical records.
• Validate diagnoses, procedures, MCC/CC capture, and overall DRG assignment.
• Identify coding discrepancies, clinical validation issues, and potential reimbursement risks.
• Review clinical documentation to ensure diagnoses are clinically supported and appropriately coded.
• Ensure compliance with CMS, ICD-10, payer-specific guidelines, and reimbursement methodologies.
• Conduct quality audits and document findings accurately.
• Provide recommendations for coding accuracy, compliance, and process improvement.