DRG Reviewer
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Job Location:
Monthly Salary:
Posted on:
9 hours ago
Vacancies:
1 Vacancy
Job Summary
JD:
Key Responsibilities
- Medical Record Review: Analyze inpatient medical records including physician notes labs and imaging to validate DRG assignments and SOI/ ROM scores
- Coding Validation: Check ICD-10-CM/PCS codes against official guidelines clinical evidence and payer policies. Changes to accurately reflect the correct DRG and/or SOI/ROM scores.
- DRG Regrouping an or rebilling: Use software to regroup claims and determine the appropriate DRG SOI/ROM or send corrected bills for submission to our PFS Department.
- Documentation & Reporting: Write clear evidence-based rationales for code/DRG changes document and report findings
- Compliance: Ensure adherence to HIPAA and other healthcare regulations.
- Collaboration: Work with coding staff supervisors and leadership to improve coding accuracy
Essential Skills & Qualifications
- Certifications: CCS CIC RHIA RHIT CCDS or similar coding/documentation credentials.
- Experience: Strong Knowledge and experience in Inpatient coding a must. Experience with Inpatient auditing clinical documentation integrity or recovery auditing is helpful.
- Knowledge: Strong understanding of ICD-10-CM/PCS MS-DRG/APR-DRG SOI/ROM scoring and Medicare guidelines.
- Technical: Proficiency with coding software and Electronic Health Record (EHR) systems.
- Soft Skills: Strong critical thinking communication (written/verbal) and self-motivation.
Key Skills
- Facilities Management
- Banking
- Content Writing
- Customer Support
- Fun
- Airlines
