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Inpatient DRG Reviewer

3 months ago

Atlanta, Georgia, United States Zelis Full time

Position Overview:

The Inpatient DRG Reviewer will be responsible for conducting comprehensive inpatient DRG reviews based on industry-standard coding guidelines, clinical criteria, and policy exclusions.

Key Responsibilities:

  • Conduct comprehensive inpatient DRG validation reviews
  • Determine accurate DRG based on coding guidelines and clinical evidence
  • Record appropriate Diagnosis Codes, Procedure Codes, and Discharge Status
  • Document all audit aspects including provider communications
  • Identify new DRG coding concepts
  • Manage assigned claims and report
  • Meet productivity and quality standards
  • Recommend methods to improve procedures
  • Achieve personal production and savings quota
  • Maintain adherence to standards regarding privacy

Skills, Knowledge, and Experience:

  • Registered Nurse licensure preferred
  • Inpatient Coding Certification required
  • 5+ years reviewing ICD-10 CM, MS-DRG claims preferred
  • Solid understanding of audit techniques and revenue opportunities
  • Experience with Health Insurance and Medicare guidelines
  • Clinical skills in Medical Record Coding
  • Experience in root cause analysis
  • Strong organization and communication skills

As a leading payments company in healthcare, Zelis provides a better financial experience by aligning the interests of payers, providers, and consumers for transparent care.

Commitment to Diversity, Equity, Inclusion, and Belonging

Zelis values diversity and creates an inclusive environment where authenticity is encouraged.

Equal Employment Opportunity

Zelis is an equal opportunity employer valuing diversity and inclusion in the workplace.

Accessibility Support: We provide accommodations for individuals with disabilities during the application process.

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