Inpatient DRG Reviewer (NC Licensed)

Job Summary

To support the Price Optimization division, the full-time Inpatient DRG Reviewer (NC Licensed) will conduct comprehensive inpatient DRG reviews and validations, ensuring accuracy based on coding guidelines and clinical evidence, while working remotely.

Key responsibilities

• Perform comprehensive inpatient DRG validation reviews to ensure accuracy of billed DRGs based on coding guidelines and medical records
• Conduct readmission reviews to evaluate preventability and compliance with policies
• Document audits and communications, providing rationale for any revised coding and DRG determinations

Required qualifications

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