This role reviews inpatient records for DRG clinical validation, assessing whether documented diagnoses are supported by the medical record and coding standards. The work is focused on chart review and coding support rather than direct patient care, with collaboration across clinical and coding teams to improve documentation accuracy and reimbursement integrity.
Key Responsibilities
- Conduct inpatient chart reviews to validate DRG assignment and diagnosis documentation.
- Review clinical evidence to determine whether coded conditions are supported in the medical record.
- Identify documentation gaps and recommend clarification or query opportunities.
- Coordinate with coding, CDI, and clinical teams to resolve validation issues.
- Use established coding guidelines and clinical criteria to support review decisions.
- Document review findings and communicate rationale for clinical validation outcomes.
Required
- Active RN license.
- Clinical nursing background with experience reviewing medical records or chart documentation.
- Knowledge of inpatient coding, DRG assignment, or clinical documentation integrity.