DRG Reviewer (Healthcare)

TL;DR

DRG Reviewer (Healthcare): Conducting thorough DRG payment validation reviews, including clinical and coding assessments of medical records with an accent on regulatory requirements and coding protocols. Focus on auditing patient medical records to ensure accurate reimbursement and providing evidence-based rationale for code recommendations.

Location: Remote (Must be based in the US)

Salary: $90,000 - $115,000

Company

A leading healthcare intelligence company providing an AI-powered platform to maximize financial outcomes and drive down healthcare costs for health plans.

What you will do

• Audit patient medical records using clinical, coding, and payer guidelines to ensure accurate reimbursement.
• Provide clear, evidence-based rationale for code recommendations or reconsiderations to providers or payers.
• Collaborate with team leaders to ensure thorough review of DRG denials.
• Use proprietary auditing systems to make consistent determinations and generate audit letters.
• Ensure strict compliance with HIPAA regulations for protected health information.

Requirements

• Degree in Nursing (active/unrestricted license) or Health Information Management.
• Certification in RHIA, RHIT, CCDS, CDIP, CCS, or CIC is required.
• 2+ years of experience in inpatient claims auditing, quality assurance, recovery auditing, or Clinical Documentation Integrity.
• Expertise in DRG methodologies (MS & APR) and ICD-10-CM/PCS coding.
• Must be based in the US and authorized to work (E-Verify).

Culture & Benefits

• Digital-first environment with the ability to work from anywhere in the US.
• Comprehensive Medical, Dental, and Vision offerings.
• Competitive salary, 401(k) with company match, and FSA/HSA options.
• Tuition reimbursement and flexible PTO.
• Trusting and empowering work environment focused on employee success.