Position Name-
Specialist DRG (DRG Validation)

Experience -
3+ years of overall experience with 1+ years of experience in Quality Analysis within the healthcare / RCM domain.

Position Summary-

Performs documentation and coding audits for all acute inpatient services for clients. Identifies coding errors, compliance, and educational opportunities, and optimizes reimbursement by ensuring that the diagnosis/procedure codes and supporting documentation accurately support the services rendered and comply with ethical coding standards/guidelines and regulatory requirements. Performs independent reviews, interprets medical records, and applies in-depth knowledge of coding principles to determine billing/coding/documentation issues and quality concerns. Demonstrates high level of expertise in researching requirements necessary to make compliant recommendations.

Job Responsibilities -
- Conducts DRG (ex. MS, APR, Tricare) coding and clinical reviews to verify the accuracy of coding, DRG assignment and clinical indicators in accordance with coding and documentation guidelines.



Ensures that the assigned DRG reflects the severity of the patient’s condition and the resources used during their hospital stay.
- Assesses whether the clinical documentation supports the coded diagnoses and procedures. Verifies that the medical record adequately justifies the assigned DRG.
- Combines medical record coding guidelines, clinical principles, and industry trends to explain any recommended changes needed by coders. Works closely with CDI (Clinical Documentation Integrity) specialists to determine if there are documentation and/or query opportunities.
- Maintains productivity and quality goals as set by audit leaders.
- Writes transparent, accurate and concise recommendations in support of findings while providing feedback and education to acute inpatient coders, referencing current ICD-10-CM/PCS Official Coding Guidelines and AHA Coding Clinics.
- Ensures acute inpatient coding audits are com

📌 Specialist DRG (Hyderabad)
🏢 ensemble global
📍 Hyderabad