DRG Clinical Validation Team Lead

Summary

Join MedReview, a leading authority in payment integrity solutions, as a Registered Nurse leading a team of clinical reviewers. You will be responsible for ensuring accurate validation of Diagnosis-Related Groups (DRGs) to maintain proper claim adjudication, compliance, and reimbursement accuracy. The ideal candidate possesses strong clinical and coding backgrounds, excellent communication skills, and an analytical mindset. This full-time, remote position offers flexibility to work from anywhere in the US, with virtual training provided. The role involves mentoring a team, conducting DRG validation reviews, monitoring performance metrics, and collaborating with other teams. MedReview offers a competitive salary and a comprehensive benefits package.

Requirements

• Registered Nurse (RN) license of MD required
• Minimum 5 years clinical experience, with at least 3 years in DRG clinical validation
• Strong knowledge of coding systems and CMS guidelines

Responsibilities

• Lead and mentor a team of clinical DRG validators to ensure high-quality, consistent chart reviews
• Conduct DRG validation reviews to ensure appropriate coding, sequencing, and documentation
• Monitor performance metrics, review quality audits, and provide ongoing feedback and training
• Collaborate with coding, compliance, and audit teams to address discrepancies and improve documentation practices
• Serve as a subject matter expert on DRG guidelines, payer-specific requirements, and clinical documentation standards
• Assist with onboarding, training, and performance development of new and existing team members
• Stay current with validation updates and coding changes to ensure team alignment

Preferred Qualifications

• Leadership experience or prior team lead/supervisory role preferred
• Certified Coding Specialist (CCS) or Clinical Documentation Improvement certification (e.g., CCDS, CDIP) a plus

Benefits

• Healthcare that fits your needs - We offer excellent medical, dental, and vision plan options that provide coverage to employees and dependents
• 401(k) with Employer Match - Join the team and we will invest in your future
• Generous Paid Time Off - Accrued PTO starting day one, plus additional days off when you’re not feeling well, to observe holidays
• Wellness - We care about your well-being. From Commuter Benefits to FSAs, we’ve got you covered
• Learning & Development - Through continued education/mentorship on the job and our investment in LinkedIn Learning, we’re focused on your growth as a working professional