DRG Reviewer

DRG Reviewer

At MedReview, our mission is to bring accuracy, accountability, and clinical excellence to healthcare. We are a leading authority in payment integrity solutions, including DRG Validation, Cost Outlier, and Readmission Reviews. Under the direction of the DRG Operations leadership team, the DRG Reviewer conducts reviews of inpatient claims to ensure coding accuracy and appropriate DRG assignment while identifying cases requiring clinical review to support coded diagnoses. This is a fully remote position. Candidates must be available to work Eastern Standard Time (EST) business hours. Salary: $85,000-$90,000 annually, commensurate with 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.

Performance Expectations:

• 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.

Qualifications:

• 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.

Remote Work Requirements:

• High speed internet (100 Mbps per person recommended) with secured WIFI.
• A dedicated workspace with minimal interruptions to protect PHI and HIPAA information.
• Must be able to sit and use a computer keyboard for extended periods of time.

Benefits and perks include:

• 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.