Remote DRG Reviewer

Job Summary

Working remotely on a full-time basis, the Remote DRG Reviewer will independently conduct comprehensive reviews of MS-DRG and APR-DRG coding and clinical documentation to ensure accurate DRG assignment and compliance with regulations.

Key responsibilities

• Independently conduct MS-DRG and APR-DRG coding reviews, verifying ICD-10-CM/PCS assignments and identifying discrepancies
• Collaborate with the Medical Director on complex cases, providing expert recommendations to influence review outcomes
• Prepare clear audit findings and evaluate claims for compliance with state and federal regulations while managing workflow autonomously

Required qualifications

• Associate's Degree in Health Information Management, Nursing, or a related field
• 4+ years of experience in MS-DRG and APR-DRG coding
• 2+ years of experience performing DRG reviews for a Payment Integrity vendor or Payer
• 2+ years of experience using DRG encoder/grouper software
• RHIT, RHIA, CCS, CICP, or CCDS certification required