DRG Coding Validation Specialist

Job Description:

DRG Coding Validation Specialist

Job Details

Level ExperiencedJob Location California Office - Roseville, CAPosition Type Full TimeEducation Level High SchoolSalary Range $73000.00 - $105000.00 Salary/yearTravel Percentage NoneJob Shift DayJob Category Insurance

About the Opportunity

At Machinify, we’re constantly reimagining what’s possible in our industry—creating disruptively simple, powerfully clear ways to maximize our clients’ financial outcomes today and drive down healthcare costs tomorrow. As part of the Complex Payment Solutions Team, as a DRG Coding Validation Specialist, you will conduct thorough reviews of provider medical records to validate the accuracy of ICD-10/PCS coding and ensure the correct assignment of Diagnosis-Related Groups (DRG). This role involves applying customer-specific payment policies, ensuring compliance with regulatory requirements, and supporting accurate reimbursement practices. The specialist works collaboratively with healthcare providers and internal teams to uphold coding quality standards, identify potential coding discrepancies, and provide detailed rationales for adjustments. By maintaining expertise in coding guidelines and industry standards, this position plays a vital role in safeguarding data integrity and optimizing financial outcomes.

What you’ll do

• Conduct data quality reviews of inpatient medical records to verify ICD-10/PCS codes and DRG/APR DRG accuracy.
• Maintain expertise in ICD-10/PCS coding conventions, Official Coding Guidelines, and AHA Coding Clinic.
• Apply customer-specific payment policies.
• Validate patient data by reconciling claims with medical records.
• Provide written rationale for coding changes affecting DRG assignments, citing official guidelines and conventions.
• Identify and audit high-risk cases for potential errors.
• Attend team meetings and training sessions as required.
• Utilize computer applications, DRG Grouper/Pricer software, and ICD-10-CM encoder software.
• Adhere to AHIMA Standards of Ethical Coding.

What experience you bring (Role Requirements)

Certifications: (minimum of 1 of the following coding credentials required)

• Registered Health Information Administrator (RHIA),
• Registered Health Information Technician (RHIT),
• Certified Coding Specialist (CCS), CCS-P AHIMA

• National certification: RHIA, RHIT, or CCS.
• At least 5 years of hospital inpatient coding for PPS reimbursement or 2+ years in DRG validation.
• Strong oral and written communication skills.
• In-depth knowledge of DRG structure and regulatory standards.
• Must meet or exceed acceptable active time on system expectations during set business hours within the employee's time zone.

Pay range: $73,000-$105,000 USD

This is an exempt position. The salary range is for Base Salary. Compensation will be determined based on several factors including, but not limited to, skill set, years of experience, and the employee’s geographic location.

What’s in it for you

• PTO, Paid Holidays, and Volunteer Days
• Eligibility for health, vision and dental coverage, 401(k) plan participation with company match, and flexible spending accounts
• Tuition Reimbursement
• Eligibility for company-paid benefits including life insurance, short-term disability, and parental leave.
• Remote and hybrid work options

We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace. Machinify is an employment at will employer.