DIAGNOSIS RELATED GROUP SPECIALIST

City/State:

Tarrytown, New York

Grant Funded:

No

Department:

HIM - Clinical Coding - Qlty and Integrity

Work Shift:

Day

Work Days:

MON-FRI

Scheduled Hours:

8:30 AM-4:30 PM

Scheduled Daily Hours:

7.5 HOURS

Pay Range:

$68,000.00-$85,000.00

Job Summary

The DRG Validator is a coding quality and compliance professional responsible for conducting complex and high-impact coding audits across inpatient (IP) encounters. Validates code accuracy, guideline compliance, and documentation support to ensure coding integrity and reduce denial risk. This role supports organizational coding quality initiatives by identifying audit trends, performing root cause analysis, ensuring audit defensibility, providing coder feedback, and supporting coding education strategies. The DRG Validator is required to use approved audit tools and scrubbers, including PWC SMART, to support audit targeting, audit documentation, and review consistency.

Qualifications:

• High School Diploma or equivalent required
• Associate’s or Bachelor’s degree preferred
• CCS required
• RHIA/RHIT, CPC, CRC, CDIP, or CCDS preferred
• Minimum of 5 years coding experience preferred (acute care strongly preferred)
• Minimum of 2 years auditing/quality review experience preferred
• Demonstrated expertise in DRG and inpatient coding principles required if assigned to IP audits
• Expert-level knowledge of official coding guidelines and sequencing rules
• Strong clinical documentation interpretation skills
• Ability to apply independent professional judgment in audit conclusions
• Ability to clearly articulate and defend audit outcomes using guidelines
• Strong written communication skills for defensible documentation
• Strong attention to detail, productivity focus, and ability to meet strict deadlines
• Proficiency in Epic and related coding/audit tools preferred
• Ability to work independently with minimal supervision while remaining accountable for quality and timeliness

Montefiore Medical Center is an equal employment opportunity employer. Montefiore Medical Center will recruit, hire, train, transfer, promote, layoff and discharge associates in all job classifications without regard to their race, color, religion, creed, national origin, alienage or citizenship status, age, gender, actual or presumed disability, history of disability, sexual orientation, gender identity, gender expression, genetic predisposition or carrier status, pregnancy, military status, marital status, or partnership status, or any other characteristic protected by law.