Job Title: RN DRG Coding Validator / Auditor

Location: Remote / Virtual (U.S. Based)

Position Type: Full-Time, Direct Hire

Salary Range: $90,000 - $120,000 / year (Dependent on experience)

Job Summary

Are you a Registered Nurse with a passion for data integrity, clinical accuracy, and medical coding? We are seeking a dual-expert RN DRG Coding Validator to join our small, innovative clinical team. This role integrates advanced clinical nursing knowledge with expert inpatient coding proficiency to perform comprehensive post-payment validation of Diagnosis-Related Group (DRG) assignments and associated inpatient medical record coding.

In this role, you will evaluate both the clinical validity of documented diagnoses and the accuracy of ICD-10-CM/PCS code assignments, DRG sequencing, and discharge dispositions. Serving insurance payers, you will identify coding inaccuracies, unsupported clinical documentation, and DRG assignment errors across MS-DRG and APR-DRG methodologies to help pinpoint overpayments.

Primary Duties & Responsibilities

• Clinical Chart Review: Review inpatient medical records in their entirety (H&Ps, progress notes, operative reports, discharge summaries) to evaluate clinical support for reported diagnoses and procedures.

• Clinical Validation: Apply nursing expertise to assess whether documented conditions meet established clinical criteria (e.g., Sepsis-3, SIRS, HAC definitions) sufficient to support code assignment, including CC and MCC designations.

• Coding Validation: Validate ICD-10-CM principal and secondary diagnosis codes, ICD-10-PCS procedure codes, sequencing, present-on-admission (POA) indicators, and discharge disposition in accordance with CMS Official Guidelines.

• Audit Determination: Evaluate MS-DRG and APR-DRG assignment accuracy, identifying opportunities for upgrades and downgrades based on documented clinical evidence.

• Write Rationales: Produce clear, accurate, and concise written rationales for all validation findings, citing applicable Official Coding Guidelines, Coding Clinic references, and clinical criteria.

• Maintain Production Metrics: Manage a daily workload of approximately 15 to 20 case reviews. Note: Case review efficiency is highly accelerated due to our cutting-edge internal AI record-summarization tool.

Required Qualifications

• Licensure: Active Registered Nurse (RN) license in the United States (compact or state-specific accepted and in good standing).

• Coding Certification: Certified Inpatient Coder (CIC) or Coding and Classification Specialist (CCS) issued by AHIMA or AAPC (current and in good standing).

• Clinical Experience: Minimum of 5 years of acute care inpatient hospital experience.

• Specialized Experience: At least 3 years in a dedicated inpatient coding, DRG validation, or Clinical Documentation Improvement (CDI) role.

• Methodology Expertise: 2+ years of dedicated experience working with APR-DRG reimbursement methodologies, Severity of Illness (SOI), and Risk of Mortality (ROM) levels.

• Technical Proficiency: Demonstrated mastery of ICD-10-CM/PCS code assignment, MS-DRG methodologies, and CMS Official Guidelines for Coding and Reporting.

Preferred Skills

• Experience utilizing Encoder Software (e.g., 3M, Optum360, Nuance).

• Comfortable leveraging and utilizing AI technology tools to optimize daily workflow and increase productivity.

• Ability to work highly independently and maintain personal accountability in a remote environment.

Schedule & Shift Flexibility

• Standard 40-hour work week.

• Flexible Scheduling: Enjoy flexible scheduling options once you are fully ramped up. The majority of our current team elects to work a 4x10 schedule (four 10-hour days) for an extended weekend!

Why You'll Love Working Here (Benefits & Perks)

We believe our team deserves the best, which is why we offer an industry-leading compensation and rewards package that starts on day one:

• Financial Incentives: Eligible after your first 90 days for a monthly performance bonus based on revenue returned to clients (typically ranging between $1,000–$1,500/month).

• Health & Wellness: Medical, dental, and vision insurance coverage beginning on your very first day. Plus, company-paid access to virtual counseling and telemedicine.

• Retirement & Security: 401(k) with company match and immediate vesting, alongside company-paid Short-Term Disability (STD).

• Work From Home Setup: A one-time home office supply stipend to customize your workstation (company laptop and charging cables provided).

• Work-Life Balance: Generous time off including 4 weeks of vacation accrual starting day one, 1 additional dedicated week for wellness, 9 paid company holidays, and 2 floating holidays.

• Family Support: Paid Parental Leave to focus on your family during life's special chapters.

• Extra Perks: Company-paid personal financial advising, choice of two carrier options for pet insurance, and a $500 annual professional development stipend after your first year to invest in your continuous growth.

^*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).

^*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.