You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.

Job Summary

Our client is seeking a skilled Validator to perform concurrent and retrospective clinical validation reviews for MS-DRG and APR-DRG assignments. The role involves ensuring compliance with UHDDS, Medicare, and federal/state regulations through accurate assignment of ICD-10-CM diagnosis and ICD-10-PCS procedure codes.

Key Responsibilities

• Perform concurrent and retrospective clinical validation reviews for MS-DRG and APR-DRG assignments in compliance with UHDDS, Medicare, and federal/state regulations.
• Validate accurate assignment of ICD-10-CM diagnosis and ICD-10-PCS procedure codes.
• Utilize encoders, EMRs, and auditing tools (e.g., 3M, EPIC, TruCode) to support audit determinations.
• Prepare clear, concise audit rationales and documentation findings.
• Draft physician queries to clarify documentation and ensure coding accuracy.
• Provide coder education with references to Official Coding Guidelines and AHA Coding Clinic.
• Review DRG/coding denials and draft well-supported appeal letters to payers, RAC, PRO, and third-party auditors.
• Issue written recommendations for optimal coding, DRG, and SOI assignment.
• Stay current on coding regulations and guideline updates.
• Meet or exceed productivity and quality standards set by HIM leadership (95–100% accuracy required).
• Communicate effectively with physicians, CDI staff, and clinical teams regarding documentation and coding guidelines.

Qualifications

• AHIMA certification required: CCS, RHIT, or RHIA.

Experience

• 5+ years of DRG/Clinical Validation, claims auditing, quality assurance, or recovery auditing experience.
• 5+ years of hands-on experience with ICD-10-CM/PCS, MS-DRG, and APR-DRG methodologies.

Skills

• Strong knowledge of medical terminology, anatomy, CPT, modifiers, reimbursement systems, and payer policies.
• Expert understanding of Official Coding Guidelines, Coding Clinic, CMS regulations, and compliance standards.
• Proficiency with Microsoft Office (Outlook, Word, Excel, PowerPoint), 3M, TruCode, Teams, SharePoint, and related systems.
• Strong written and verbal communication skills with the ability to educate healthcare professionals.
• Highly analytical, detail-oriented, and self-sufficient.
• Ability to meet or exceed productivity and deadline expectations.

Schedule/Shift

M-F, 7AM-7PM (Flexible schedule, 40 hours per week)

Overtime available

Benefits

• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
• Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
• 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
• Short Term Disability Insurance.
• Term Life Insurance Plan.

Required Employment / Compliance Language

Medix offers competitive pay and benefits. We are an equal opportunity employer committed to the principles of diversity and inclusion.

^*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).

Medix Overview:

With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we’re dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.

^*As a job position within our Revenue Cycle division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, handling financial and other payment data, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.