{"schemaVersion":"jobsearcher.job.v1","id":"2cbce4ae2eebd596d810715a","url":"https://jobsearcher.com/jobs/2cbce4ae2eebd596d810715a","canonicalUrl":"https://jobsearcher.com/jobs/2cbce4ae2eebd596d810715a","title":"DRG Validator- Remote","description":"Job Description\nThe DRG Validation position requires an extensive background in inpatient DRG coding with a deep understanding of the MS-DRG and APR-DRG payment systems. The validator is responsible for auditing inpatient medical records, ensuring the accuracy of coding, provider documentation, and DRG assignment.\nKey Responsibilities\nPerform concurrent and retrospective clinically based and MS-DRG and APR DRG validation reviews in compliance with appropriate coding and payments adhering to Uniform\nHospital Discharge Date Set (UHDDS) and Medicare guidelines including Federal and State regulations.\nReview the correct assignment of ICD-10-CM diagnosis & ICD-10-PCS procedure codes.\nEffectively utilize facility Encoders, EMRs, abstracting systems (3M, EPIC, etc.) and auditing tools and systems (e.g., TruCode, 3M Standalone, etc.) proficiently to make audit determinations.\nWrite clear, accurate, and concise rationales supporting audit findings.\nCompose physician queries for clarification of documentation.\nProvide coder education referencing applicable coding references following audits.\nReview DRG/coding denial letters and compose effectively supported appeal response letters to third party auditors and insurance carriers that summarize and support hospital position of upholding or overturning of External, PRO and/or RAC Determinations.\nProvide written recommendations for optimal coding and DRG / SOI assignment.\nStay up to date on regulatory changes affecting coding rules and regulations.\nMaintain proficiency on the Official Coding Guidelines for Coding and Reporting and AHA\nCoding Clinics.\nMeets or Exceeds Standards / Guidelines for productivity maintaining production goals set by the Director of HIM Technical Services.\nMeets or Exceeds Standards / Guidelines for accuracy and quality achieving the expected level set by the Director of HIM Technical Services. Quality accuracy rate must be maintained at 95-100%.\nAble to effectively communicate with physicians, CDI staff and other clinicians regarding documentation, queries and/or coding guidelines.\nQualifications\nMust have one of the following AHIMA certifications: CCS, RHIT, or RHIA\nExtensive knowledge of medical terminology, anatomy, coding terminology and coding guidelines for ICD-10-CM/PCS, CPT, Modifiers, etc.\nEquivalent experience of 5+ years in DRG/Clinical Validation claims auditing, quality assurance or recovery auditing.\nMinimum of 5+ years of working with ICD-10-CM/PCS, MS-DRG, and APR-DRG with a broad knowledge of medical claims billing/payment systems, and payer reimbursement policies.\nAdherence to Official Coding Guidelines for Coding and Reporting, Coding Clinic determinations, CMS, and other regulatory compliance guidelines and mandates which requires expert coding knowledge of DRG, ICD-10-CM and PCS codes.\nDemonstrates basic skills in Microsoft Outlook, Word, Excel, PowerPoint, 3M, TruCode,Teams, SharePoint, and other applications.\nMust have good written and verbal communication skills.\nPossess the ability to educate health care professionals in various settings.\nResponsible and self-sufficient with strong analytical and research skills.\nMust be able to meet or exceed deadline completion times required.\nJob Type: Full-time\nSalary: From $80,000.00 per year\nBenefits:\n401(k)\n401(k) matching\nDental insurance\nFlexible schedule\nHealth insurance\nLife insurance\nPaid time off\nVision insurance\nSchedule:8 hour shift\nWork setting:Remote\nExperience: ICD coding: 5 years (Required)\nLicense/Certification:AHIMA Certification (Required)\nAbout Jzanus Consulting\nFor over 25 years, Jzanus has been a premier provider of revenue integrity HIM services. Quality and trust, along with personal and professional integrity have been the cornerstones upon which we built our reputation and our success. Jzanus’s accomplishments are the result of our New York best practice experience, our proprietary technology platform and most importantly the Jzanus team. Our people are senior level professionals with extensive provider, payer, clinical, HIM and home care experience who are very aware of the business challenges that face you daily. Jzanus Consulting specializes in providing HIM coding validation, clinical documentation improvement, and cost outlier recovery to hospitals and hospital-owned physician organizations. We have earned the trust of our customers by utilizing only the most qualified HIM consultants. By ensuring compliance and coding accuracy for optimal reimbursements, we provide significant value to our customers.","company":"Jzanus Consulting","rawCompany":"jzanus consulting","isRemote":true,"isActive":false,"createdAt":"2026-08-15T12:43:24.657Z","occupations":[{"code":"29-9021.00","title":"Health Information Technologists and Medical Registrars","slug":"health-information-technologists-and-medical-registrars"},{"code":"29-2072.00","title":"Medical Records Specialists","slug":"medical-records-specialists"},{"code":"31-9094.00","title":"Medical Transcriptionists","slug":"medical-transcriptionists"}],"industries":[{"code":"621999","title":"All Other Miscellaneous Ambulatory Health Care Services","slug":"all-other-miscellaneous-ambulatory-health-care-services"},{"code":"622110","title":"General Medical and Surgical Hospitals","slug":"general-medical-and-surgical-hospitals"},{"code":"621111","title":"Offices of Physicians (except Mental Health Specialists)","slug":"offices-of-physicians-except-mental-health-specialists"}],"jobPosting":{"@context":"https://schema.org","@type":"JobPosting","title":"DRG Validator- Remote","description":"Job Description\nThe DRG Validation position requires an extensive background in inpatient DRG coding with a deep understanding of the MS-DRG and APR-DRG payment systems. The validator is responsible for auditing inpatient medical records, ensuring the accuracy of coding, provider documentation, and DRG assignment.\nKey Responsibilities\nPerform concurrent and retrospective clinically based and MS-DRG and APR DRG validation reviews in compliance with appropriate coding and payments adhering to Uniform\nHospital Discharge Date Set (UHDDS) and Medicare guidelines including Federal and State regulations.\nReview the correct assignment of ICD-10-CM diagnosis & ICD-10-PCS procedure codes.\nEffectively utilize facility Encoders, EMRs, abstracting systems (3M, EPIC, etc.) and auditing tools and systems (e.g., TruCode, 3M Standalone, etc.) proficiently to make audit determinations.\nWrite clear, accurate, and concise rationales supporting audit findings.\nCompose physician queries for clarification of documentation.\nProvide coder education referencing applicable coding references following audits.\nReview DRG/coding denial letters and compose effectively supported appeal response letters to third party auditors and insurance carriers that summarize and support hospital position of upholding or overturning of External, PRO and/or RAC Determinations.\nProvide written recommendations for optimal coding and DRG / SOI assignment.\nStay up to date on regulatory changes affecting coding rules and regulations.\nMaintain proficiency on the Official Coding Guidelines for Coding and Reporting and AHA\nCoding Clinics.\nMeets or Exceeds Standards / Guidelines for productivity maintaining production goals set by the Director of HIM Technical Services.\nMeets or Exceeds Standards / Guidelines for accuracy and quality achieving the expected level set by the Director of HIM Technical Services. Quality accuracy rate must be maintained at 95-100%.\nAble to effectively communicate with physicians, CDI staff and other clinicians regarding documentation, queries and/or coding guidelines.\nQualifications\nMust have one of the following AHIMA certifications: CCS, RHIT, or RHIA\nExtensive knowledge of medical terminology, anatomy, coding terminology and coding guidelines for ICD-10-CM/PCS, CPT, Modifiers, etc.\nEquivalent experience of 5+ years in DRG/Clinical Validation claims auditing, quality assurance or recovery auditing.\nMinimum of 5+ years of working with ICD-10-CM/PCS, MS-DRG, and APR-DRG with a broad knowledge of medical claims billing/payment systems, and payer reimbursement policies.\nAdherence to Official Coding Guidelines for Coding and Reporting, Coding Clinic determinations, CMS, and other regulatory compliance guidelines and mandates which requires expert coding knowledge of DRG, ICD-10-CM and PCS codes.\nDemonstrates basic skills in Microsoft Outlook, Word, Excel, PowerPoint, 3M, TruCode,Teams, SharePoint, and other applications.\nMust have good written and verbal communication skills.\nPossess the ability to educate health care professionals in various settings.\nResponsible and self-sufficient with strong analytical and research skills.\nMust be able to meet or exceed deadline completion times required.\nJob Type: Full-time\nSalary: From $80,000.00 per year\nBenefits:\n401(k)\n401(k) matching\nDental insurance\nFlexible schedule\nHealth insurance\nLife insurance\nPaid time off\nVision insurance\nSchedule:8 hour shift\nWork setting:Remote\nExperience: ICD coding: 5 years (Required)\nLicense/Certification:AHIMA Certification (Required)\nAbout Jzanus Consulting\nFor over 25 years, Jzanus has been a premier provider of revenue integrity HIM services. Quality and trust, along with personal and professional integrity have been the cornerstones upon which we built our reputation and our success. Jzanus’s accomplishments are the result of our New York best practice experience, our proprietary technology platform and most importantly the Jzanus team. Our people are senior level professionals with extensive provider, payer, clinical, HIM and home care experience who are very aware of the business challenges that face you daily. Jzanus Consulting specializes in providing HIM coding validation, clinical documentation improvement, and cost outlier recovery to hospitals and hospital-owned physician organizations. We have earned the trust of our customers by utilizing only the most qualified HIM consultants. By ensuring compliance and coding accuracy for optimal reimbursements, we provide significant value to our customers.","datePosted":"2026-08-15T12:43:24.657Z","dateModified":"2026-08-15T12:43:24.657Z","hiringOrganization":{"@type":"Organization","name":"Jzanus Consulting","sameAs":"https://jobsearcher.com"},"jobLocationType":"TELECOMMUTE","applicantLocationRequirements":{"@type":"Country","name":"US"},"identifier":{"@type":"PropertyValue","name":"JobSearcher","value":"2cbce4ae2eebd596d810715a"},"url":"https://jobsearcher.com/jobs/2cbce4ae2eebd596d810715a"}}