What are the responsibilities and job description for the DRG Coding Validation Specialist position at Lifelancer?
Job Title : DRG Coding Validation Specialist
Job Location : Roseville CA USA
Job Location Type : Remote
Job Contract Type : Fulltime
Job Seniority Level : Associate
Who We Are
As a leading healthcare intelligence company with over 40 years of experience we put our unrivaled payment integrity subrogation and coordination of benefits (COB) expertise expansive perspective and relentless focus to work for our clients—ensuring no stone is left unturned in our pursuit of unmatched results. Our commitment to accuracy and excellence has helped us grow into a proven leader of our industry relied on by companies large and small to help them maximize their return on investment.
Location : This role is full remote
About The Opportunity
At NewCo 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 ICD10 / PCS coding and ensure the correct assignment of DiagnosisRelated Groups (DRG). This role involves applying customerspecific 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 ICD10 / PCS codes and DRG / APR DRG accuracy.
- Maintain expertise in ICD10 / PCS coding conventions Official Coding Guidelines and AHA Coding Clinic.
- Apply customerspecific 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 highrisk cases for potential errors.
- Attend team meetings and training sessions as required.
- Utilize computer applications DRG Grouper / Pricer software and ICD10CM 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)
What Success Looks Like…
After 3 months
After 1 year
Pay range : $73000$105000 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
At NewCo we’re reimagining a simpler way forward. This begins with our employees. We are innovators who value integrity teamwork accuracy and flexibility. We do the right thing and we listen to the needs of our clients and their members. As tenured experts with unmatched experience we champion diverse perspectives that help us to better understand and serve our clients.
Our values come to life through our culture. We embrace flexible working arrangements that allow our employees to bring innovation to life in the way that best suits their productivity. We work crossfunctionally abandoning silos to bring innovative accurate solutions to market. We invest in each other through ongoing education and team celebrations and we give back to our communities through dedicating days for volunteering. Together NewCo is making healthcare work better for everyone and we’re passionate about a future with better outcomes for all.
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. NewCo is an employment at will employer.
INDHP
Lifelancer ( ) is a talenthiring platform in Life Sciences Pharma and IT. The platform connects talent with opportunities in pharma biotech health sciences healthtech and IT domains.
For more details and to find similar roles please check out the below Lifelancer link.
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Key Skills
Python,SOC,Debugging,C / C ,FDA Regulations,Minitab,Technical Writing,GAMP,OS Kernels,Perl,cGMP,Manufacturing
Employment Type : Full Time
Vacancy : 1
Salary : $73,000 - $105,000
