DRG Validator

Job description

**Company Description** EXL is a digital operations and analytics company that partners with organizations to turn data into actionable insights and sustainable business outcomes. The company focuses on tailored solutions that align with each client’s unique needs, culture, and technology environment, rather than generic, one-size-fits-all platforms. EXL combines expertise in transformation, data science, change management, and operations with deep industry knowledge to improve efficiency, decision-making, and revenue growth. By leveraging analytics, digital interventions, and operations management, EXL helps clients scale AI, redesign operating models, and gain competitive advantage. For more information, visit www.exlservice.com. **Role Description** The DRG Validator is responsible for reviewing coded inpatient medical records to validate Diagnosis Related Group (DRG) assignments for accuracy and compliance. In this full-time remote role, the individual analyzes clinical documentation, diagnoses, procedures, and coding to ensure appropriate DRG grouping and alignment with regulatory and payer guidelines. Day-to-day responsibilities include performing detailed chart reviews, identifying coding or documentation discrepancies, and providing feedback or queries to support accurate and complete clinical documentation. The DRG Validator collaborates with coding teams, clinical documentation improvement (CDI) specialists, and other stakeholders to reduce audit risks and optimize reimbursement integrity. The role also involves maintaining current knowledge of coding standards, DRG methodologies, and payer requirements, and participating in quality assurance and education initiatives. **Qualifications** - Candidates should possess strong medical coding skills, including experience with inpatient coding and DRG assignment (Min 2 Years) - Candidates should possess knowledge of Health Information Management principles and practices, including RHIT or similar credentials where applicable. - Candidates should possess a solid understanding of medical terminology and clinical documentation, enabling accurate interpretation of diagnoses and procedures. - Candidates should possess coding experience with relevant classification systems (e.g., ICD-10-CM/PCS) and familiarity with payer and regulatory guidelines. - Additional beneficial qualifications include certification such as CCS or CPC, experience in DRG validation or auditing, and prior work in hospital or health system environments. - Strong analytical skills, attention to detail, and the ability to work independently in a remote setting are essential. - Effective written and verbal communication skills and comfort collaborating with multidisciplinary teams are highly desirable.