Remote DRG Reviewer (MO Licensed)

Working remotely on a full-time basis, the Remote DRG Reviewer (MO Licensed) will conduct comprehensive reviews of MS-DRG and APR-DRG coding and clinical documentation to ensure accuracy in DRG assignment and reimbursement, requiring advanced expertise in ICD-10-CM/PCS coding. 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 and company policies, 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 RHIT, RHIA, CCS, CICP, CCDS certification, or RN licensure required