State Licensed DRG Dispute Reviewer
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Job Summary
Evaluating provider appeals and original audit findings, the remote State Licensed DRG Dispute Reviewer will determine correct DRG assignments and payment outcomes, ensuring compliance and accuracy in documentation and reimbursement practices.
Key responsibilities
- Evaluate provider-submitted appeals and original audit findings to validate or revise DRG determinations
- Review inpatient medical records and documentation for correct DRG assignment and adherence to coding guidelines
- Prepare clear, evidence-based rationales to support determinations for clients, providers, or payers
Required qualifications
- An associate or bachelor's degree in nursing or health information management, or equivalent work experience
- At least one relevant certification: RHIA, RHIT, CCS, CIC, CDIP, or CCDS
- Minimum 3 years of inpatient hospital coding experience
- Minimum 4 years of DRG validation experience, with a preference for dispute review and recovery audits
- Expert-level knowledge of ICD-10-CM/PCS coding systems and MS-DRG/APR-DRG methodologies
Complete Job Description
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