Inpatient DRG Reviewer

Job Summary

A company is looking for an Inpatient DRG Sr. Reviewer.

Key Responsibilities

• Conduct comprehensive inpatient DRG validation Quality Assurance reviews based on coding guidelines and clinical evidence
• Implement and manage quality assurance programs to ensure accurate results for clients
• Prepare and conduct training for new team members while serving as a Subject Matter Expert on DRG validation

Required Qualifications, Training, and Education

• Registered Nurse licensure preferred
• Inpatient Coding Certification required (e.g., CCS, CIC, RHIA, RHIT)
• 5+ years of experience reviewing and/or auditing ICD-10 CM, MS-DRG, and APR-DRG claims preferred
• Strong understanding of hospital coding and billing rules
• Experience with Health Insurance and Medicare guidelines