Clinical Reimbursement Manager

Job Summary

A company is looking for a Clinical Reimbursement Manager to perform quality reviews of medical records and validate coding accuracy.

Key Responsibilities

• Conducts focused reviews on ICD-10-CM/PCS coded inpatient medical records to ensure accuracy and identify additional diagnoses/procedures
• Validates DRG assignments flagged pre-billing and determines the need for secondary reviews
• Initiates physician queries to clarify documentation and reconciles coding discrepancies with insurers and vendors

Required Qualifications

• Strong background in anatomy, physiology, and pharmacology
• 3 to 5 years of experience coding in an acute care hospital
• Experience with ICD-10-CM and ICD-10-PCS coding
• Knowledge of MS-DRGs and APR-DRGs reimbursement methodology
• Familiarity with electronic health records and data systems