Certified DRG Reviewer

Job Summary

To enhance payment integrity, the full-time Certified DRG Reviewer will analyze inpatient medical records and claims for coding accuracy and DRG assignment while working remotely during Eastern Standard Time (EST) hours.

Key Responsibilities

• Review and analyze inpatient medical records and claims to validate coding accuracy and appropriate DRG assignment
• Identify coding discrepancies and reimbursement opportunities while ensuring compliance with coding guidelines and regulations
• Document findings and maintain organized review records, adhering to HIPAA and confidentiality requirements

Required Qualifications

• Current coding certification such as Certified Coding Specialist (CCS) or Certified Inpatient Coder (CIC)
• Minimum of 3 years of experience in acute inpatient coding or DRG validation
• Strong knowledge of ICD-10-CM/PCS coding guidelines and DRG methodologies
• Proficiency with Microsoft Office applications, including Outlook, Word, and Excel
• Ability to work independently in a remote environment and manage multiple priorities