Diagnosis Related Group Validator

Company Description R1 RCM is a leading healthcare revenue management organization that helps providers improve financial performance through advanced technology and expert services. As a pioneer in the industry, R1 developed the first Healthcare Revenue Operating System, an intelligent platform that combines automation, AI, and human expertise to optimize the entire revenue cycle. With more than 20 years of experience, the company partners with over 1,000 providers, including 95 of the top 100 U.S. health systems, and manages more than 270 million payer transactions annually. This scale and depth of data provide strong operational insights, enabling healthcare organizations to unlock long-term value and efficiency.
Role Description The Diagnosis Related Group (DRG) Validator is a full-time, on-site role based in Hyderabad. This role focuses on reviewing medical records and clinical documentation to validate assigned DRGs, ensuring accuracy in coding and alignment with established guidelines and payer requirements. The DRG Validator analyzes diagnoses, procedures, and comorbidities, confirms appropriate DRG grouping, and identifies discrepancies or opportunities for documentation improvement. The role involves collaborating with coding teams, clinical documentation specialists, and revenue cycle staff to resolve issues, support compliant billing, and reduce denials. The DRG Validator also participates in audits, prepares summary reports, and provides feedback to enhance coding quality and revenue integrity.
Qualifications
Strong knowledge of ICD-10-CM/PCS and CPT coding systems, DRG methodologies, and inpatient coding guidelines.
Experience in clinical documentation review, chart abstraction, and medical record analysis for validation and quality assurance.
Understanding of hospital billing, reimbursement processes, and revenue cycle concepts, including payer rules and compliance standards.
Proficiency in using electronic health record (EHR) systems, coding software, and basic office productivity tools.
Relevant certification such as CCS, CPC, or equivalent coding credential; a background in nursing, HIM, or healthcare sciences is preferred.
Strong analytical and critical-thinking skills, with attention to detail and accuracy in documentation and coding review.
Effective written and verbal communication skills, with the ability to collaborate with multidisciplinary teams and explain coding decisions clearly.
Ability to work on-site in Hyderabad, manage workload independently, and meet productivity and quality targets.

Work arrangement
No