IP/OP DRG Validation Analyst

2 - 3 years

0 Lacs

Posted:5 days ago| Platform: Naukri logo

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Job Type

Full Time

Job Description

Role & Responsibilities:

  • Perform IP/OP DRG validation for hospital claims to ensure accurate coding and reimbursement.
  • Review clinical documentation and claims data to identify discrepancies and errors.
  • Collaborate with coding, clinical, and billing teams to resolve validation issues.
  • Prepare detailed validation reports and dashboards for management.
  • Ensure adherence to healthcare compliance, regulatory standards, and internal quality protocols.
  • Assist in process improvement initiatives related to DRG validation workflows.
  • Maintain up-to-date knowledge of DRG coding guidelines, payer-specific rules, and industry standards.

Preferred Candidate Profile:

  • Bachelors degree in Life Sciences, Nursing, Healthcare, or related field.
  • 2–5 years of experience in DRG validation, medical coding, or healthcare analytics.
  • Strong knowledge of IP/OP DRG coding, ICD-10, CPT, and healthcare reimbursement processes.
  • Experience with hospital billing systems, payer-specific DRG rules, and compliance standards.
  • Strong analytical and problem-solving skills with high attention to detail.
  • Proficient in MS Excel and healthcare software tools.
  • Excellent communication and interpersonal skills to collaborate with cross-functional teams.
  • Self-motivated, detail-oriented, and capable of handling large datasets accurately.

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