Medintelx DRG Auditing & AI Solutions

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.