DRG Reviewer

Position Summary

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.

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.
• Able 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.

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 Health 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.
• 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

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.