Inpatient DRG Reviewer

Job Summary

Conducting comprehensive inpatient DRG reviews, the full-time Inpatient DRG Reviewer will perform post-service and pre-payment audits based on coding guidelines and clinical criteria, ensuring accuracy and compliance while working remotely.

Key responsibilities

• Perform comprehensive inpatient DRG validation reviews to assess the accuracy of billed DRGs against medical records and coding guidelines
• Conduct readmission reviews to evaluate preventability and compliance with policies, documenting findings and recommendations
• Manage assigned claims and adhere to client turnaround times while meeting productivity and quality standards

Required qualifications

• RN or LVN required
• Inpatient Coding Certification (CCS, CIC) required within 4-6 months of hire
• 1-3 years of experience reviewing and auditing ICD-10 CM, MS-DRG, and APPR-DRG claims preferred
• Experience with Health Insurance and Medicare guidelines
• Understanding of hospital coding and billing rules