DRG Reviewer
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Job Description
DRG Reviewer conducting reviews of inpatient claims to ensure coding accuracy at MedReview. A fully remote position requiring coding certification and 3+ years of experience.
Responsibilities:
- Analyze and review inpatient claims following the Official Coding and Reporting Guidelines to validate the reported ICD-10-CM/PCS codes to ensure proper DRG assignment for accurate billing.
- Demonstrates the ability to perform a comprehensive initial review as outlined in the standard operating procedures and departmental guides.
- Collaborates with physician reviewers, as needed.
- Ability to prioritize and organize workload and complete tasks independently.
- Required attendance of all departmental team meetings and/or training.
- Work on other duties or tasks, as necessary.
- Report productivity daily utilizing department productivity report.
- Meet/exceed daily productivity expectations.
- Maintains 95% accuracy in claim reviews.
- Must be available to work a 7.5-hour workday during Eastern Standard Time (EST) business hours.
- Comply with organization policy and procedures.
Requirements:
- Coding Certification required (at least one of the following is required and must be maintained as a condition of employment).
- Certified Coding Specialist (CCS)
- Certified Inpatient Coder (CIC)
- Registered Heath Information Technician (RHIT)
- College level courses in medical terminology, anatomy, pathophysiology, pharmacology, and medical coding courses.
- At least 3 years’ experience in MS-DRG and APR-DRG validation in acute care inpatient coding, auditing.
- Payment integrity DRG validation is a plus.
- Adherence to the Official Coding and Reporting guidelines, AHA Coding Clinic determinations, and CMS and other regulatory compliance guidelines and mandates.
- Requires working knowledge of applicable industry-based standards.
- Proficiency in Outlook, Word, Excel, and other applications.
- Excellent written and verbal communication skills.
- Maintain professional credentialed status with approved continuing education programs.
- Ability to work independently and can multi-task or transition to different tasks easily.
Benefits:
- Healthcare that fits your needs - We offer excellent medical, dental, and vision plan options that provide coverage to employees and dependents.
- 401(k) with Employer Match - Join the team and we will invest in your future
- Generous Paid Time Off - Accrued PTO starting day one, plus additional days off when you’re not feeling well, to observe holidays.
- Wellness - We care about your well-being. From Commuter Benefits to FSAs we’ve got you covered.
- Learning & Development - Through continued education/mentorship on the job and our investment in LinkedIn Learning, we’re focused on your growth as a working professional.
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