Remote DRG Reviewer

Job Summary

Working remotely in a full-time capacity, the Remote DRG Reviewer will conduct comprehensive reviews of MS-DRG and APR-DRG coding and clinical documentation to ensure accuracy in DRG assignment and reimbursement, while exercising professional judgment and collaborating with the Medical Director on complex cases.

Key responsibilities

• Independently conduct MS-DRG and APR-DRG coding and clinical validation reviews, verifying ICD-10-CM/PCS assignments and identifying discrepancies
• Collaborate with the Medical Director on complex cases, providing expert recommendations to ensure clinical accuracy and compliance
• Prepare clear audit findings and evaluate claims for compliance with regulations, exercising independent judgment throughout the review process

Required qualifications

• Associate's Degree in Health Information Management, Nursing, or a related field
• 4+ years of experience performing MS-DRG and APR-DRG coding
• 2+ years of experience conducting DRG reviews for a Payment Integrity vendor or Payer
• 2+ years of experience using DRG encoder/grouper software (e.g., TruCode, 3M, Optum Encoder)
• RHIT, RHIA, CCS, CICP, CCDS certification, or RN licensure required