DRG Reviewer

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

📋 Description

• Evaluate and examine inpatient claims in accordance with the Official Coding and Reporting Guidelines to verify the accuracy of the reported ICD-10-CM/PCS codes, ensuring correct DRG assignment for precise billing.

• Exhibits the capability to conduct a thorough initial review as detailed in the standard operating procedures and departmental guidelines.

• Engages in collaboration with physician reviewers when necessary.

• Demonstrates the ability to manage and organize workload effectively while completing tasks autonomously.

• Required participation in all departmental team meetings and/or training sessions.

• Undertake additional duties or tasks as needed.

• Report daily productivity using the department's productivity report.

• Achieve or surpass daily productivity targets.

• Maintain a 95% accuracy rate in claim evaluations.

• Must be available to work a 7.5-hour day during Eastern Standard Time (EST) business hours.

• Adhere to organizational policies and procedures.

⛳️ Requirements

• A coding certification is mandatory (at least one of the following is required and must be maintained as a condition of employment).

• Certified Coding Specialist (CCS)

• Certified Inpatient Coder (CIC)

• Registered Health Information Technician (RHIT)

• Completion of college-level courses in medical terminology, anatomy, pathophysiology, pharmacology, and medical coding.

• Minimum of 3 years of experience in MS-DRG and APR-DRG validation in acute care inpatient coding and auditing.

• Experience with payment integrity DRG validation is advantageous.

• Compliance with the Official Coding and Reporting guidelines, AHA Coding Clinic decisions, and CMS as well as other regulatory compliance guidelines and mandates.

• Requires a solid understanding of relevant industry standards.

• Proficiency in Outlook, Word, Excel, and other software applications.

• Exceptional written and verbal communication abilities.

• Maintain professional credentialed status through approved continuing education programs.

• Capability to work independently and adapt to multitasking or transitioning between tasks with ease.

🏝️ Benefits

• Healthcare that fits your needs - We provide outstanding medical, dental, and vision plan options that cover both employees and their dependents.

• 401(k) with Employer Match - Become part of our team, and we will invest in your future.

• Generous Paid Time Off - Accrued PTO begins on day one, plus additional days off for illness and holidays.

• Wellness - We prioritize your well-being. From Commuter Benefits to FSAs, we've got you covered.

• Learning & Development - Through on-the-job education/mentorship and our investment in LinkedIn Learning, we are dedicated to your growth as a professional.