DRG Reviewer

This is a fully remote position, open to applicants in United States.

📋 Description

• Review patient medical records in accordance with clinical, coding, and payer guidelines to guarantee accurate reimbursement.

• Offer well-supported, evidence-based justifications for code suggestions or reevaluations to healthcare providers or payers.

• Partner with team leaders to ensure comprehensive examination of DRG denials.

• Execute audits in compliance with organizational standards for quality and timeliness.

• Utilize proprietary auditing systems effectively to make consistent decisions and produce audit letters.

• Suggest enhancements to the auditing system to improve operational efficiency.

• Maintain adherence to HIPAA regulations regarding protected health information.

• Carry out other assigned responsibilities.

⛳️ Requirements

• An associate or bachelor’s degree in nursing (with an active/unrestricted license) or in health information management is mandatory.

• Work experience may be accepted in place of formal education at the discretion of leadership.

• RHIA - Registered Health Information Administrator

• RHIT - Registered Health Information Technician

• CCDS - Certified Clinical Documentation Specialist

• CDIP - Clinical Documentation Improvement Practitioner

• CCS - Certified Coding Specialist

• CIC - Certified Inpatient Coder

• A minimum of 2 years of experience in inpatient claims auditing, quality assurance, or recovery auditing is required, along with 2 years of experience in Inpatient Clinical Documentation Integrity.

• Strong emphasis on quality and meticulous attention to detail.

• A profound curiosity and analytical abilities to identify root causes of events and behaviors.

• Proven capability to exercise critical judgment in clinical and coding decisions.

• Comprehensive understanding of clinical criteria and documentation needs for supporting code assignments.

• Expertise in DRG methodologies (e.g., MS & APR).

• Proficient in ICD-10-CM/PCS coding, UHDDS definitions, Official Coding Guidelines, and AHA’s Coding Clinic Guidelines.

• Ability to work autonomously and efficiently with minimal oversight.

🏝️ Benefits

• Work from anywhere in the US! Machinify is digital-first.

• Top-tier Medical/Dental/Vision offerings.

• FSA/HSA options available.

• Tuition reimbursement program.

• Competitive salary along with a 401(k) that includes company matching.

• Paid Time Off (PTO).

• Additional health and wellness benefits and perks.

• A flexible and trusting environment where you’ll be empowered to perform at your best.