Remote DRG Validators - QualCode Inc.

Company Name: QualCode Inc.
Job Title: DRG Validators
Work Setting:  Remote
Job Type: Full Time

Job Description:  QUALCODE INC. IS LOOKING FOR REMOTE DRG VALIDATORS TO JOIN OUR TEAM!!  This position is Remote! We are looking for individuals that have extensive experience and knowledge in DRG Validation and IPPS (MS-DRG & APR-DRG).

• Schedule(s) Available: Tuesday thru Saturday, 8:30 AM – 5:00 PM Eastern Time; Sunday thru Thursday, 8:30 AM – 5:00 PM Eastern Time; Monday thru Friday, 8:30 AM – 5:00 PM Eastern Time.
• Responsibilities: Conduct MS-DRG and/or APR-DRG coding reviews to verify the accuracy of the DRG assignment and reimbursement. Apply coding guidelines to a variety of claim scenarios and effectively utilize industry and proprietary tools. Document audit results in a clear, concise, and effective manner using AHA Coding Clinic Guidelines and ICD 10 CM/PCS coding rules and guidelines. Utilize proprietary workflow systems and encoder tools (e.g., 3M, etc.) efficiently and accurately to make audit determinations, generate audit rationales and move claims through workflow process correctly. Meet or exceed productivity and quality goals and/or benchmarks. Demonstrate knowledge of and compliance with changes and updates to coding guidelines, reimbursement trends, and client processes and requirements. Comply with policies and procedures including HIPAA and other state and federal regulations.

Certification/Experience Required:  RHIA/RHIT/CCS/CIC/CPC certification required. Minimum of 3-5 years in a DRG Validation role performing both DRG and Quality Audits. A minimum of 3 years of APR/DRG coding experience, specifically within Trauma Level II or higher facilities. Prior experience with DRG/APR-DRG validation or auditing is required. Strong and in-depth knowledge of MS-DRG & APR DRGs. Attention to detail. Ability to clearly communicate verbally and in writing. Experience working with academic teaching facilities and Level I and II Trauma Centers

Compensation:   Salary Range: $80,000-$90,000.

Benefits: Free dental, vision, and life insurance, Medical insurance, 401K retirement plan, Profit-sharing plan, PTO, Paid holidays, Competitive salary. PERK - You are not required to be on the phone with clients or physicians at any time during employment with QualCode.

Instructions for Resume Submission:  If interested in applying for our DRG Validator position, please email your resume to [email protected] for consideration.

(3/26/25 - 6/26/25)