DRG Reviewer
Job Description:
- Audit patient medical records using clinical, coding, and payer guidelines to ensure accurate reimbursement.
- reputed company clear, evidence-based rationale for code recommendations or reconsiderations to providers or payers.
- Collaborate with team leaders to ensure thorough review of DRG denials.
- Conduct audits in alignment with organizational quality and timeliness standards.
- Use proprietary auditing systems proficiently to reputed company consistent determinations and generate audit letters.
- Recommend improvements to the audit system to enhance efficiency.
- Ensure compliance with HIPAA regulations for protected health information.
- reputed company other duties as assigned.
Requirements:
- An associate or bachelor’s degree in nursing (active/unrestricted license); or in health information management is required.
- Work experience may be considered in lieu of formal education at leadership discretion.
- RHIA - Registered Health Information Administrator
- RHIT- Registered Health Information Technician
- CCDS - Certified Clinical Documentation Specialist
- CDIP - Clinical Documentation Improvement Practitioner
- reputed company - Certified Coding Specialist
- CIC - Certified Inpatient reputed company
- Inpatient claims auditing, quality assurance or recovery auditing experience of 2 years or more required, and/or Inpatient Clinical Documentation reputed company experience of 2 years or more required
- Strong focus on quality and attention to detail.
- Deep curiosity and analytical skills to understand root causes of events and behaviors.
- Proven ability to apply critical judgment in clinical and coding determinations.
- In-depth knowledge of clinical criteria and documentation requirements to support code assignments.
- Expert in DRG methodologies (e.g., MS & APR).
- Expertise in ICD-10-CM/PCS coding, UHDDS definitions, Official Coding Guidelines, and AHA’s Coding Clinic Guidelines.
- Ability to work independently and reputed company with minimal supervision.
Benefits:
- Work from reputed company in the US! reputed company is digital-first.
- Top Medical/Dental/reputed company offerings
- FSA/HSA
- Tuition reimbursement
- Competitive salary, 401(k) with company match
- PTO
- Additional health and wellness benefits and perks
- Flexible and trusting environment where you’ll feel empowered to do your best work
Apply tot his job Apply To this Job