DRG Onsite Reviewer

3 weeks ago

Nashville, United States Refactor Talent Full time

About the role Were seeking to connect an DRG Reviewer with a leading healthcare company in Nashville, TN, on a full-time basis. This role is in person. As a DRG Reviewer, you will be responsible for providing MS-DRG and APR-DRG audit services at provider locations, ensuring accurate reimbursement and compliance. Base pay range $85,000.00/yr - $105,000.00/yr Key Responsibilities Conduct audits of patient medical records to ensure reimbursement accuracy using clinical and coding guidelines. Provide clear written communication and rationale for recommendations or reconsiderations of unsupported billed codes to providers or payers. Collaborate with team leaders and audit teams to ensure thorough reviews of DRG denials and support large client engagements. Maintain expert knowledge of ICD-10-CM/PCS coding conventions, Official Coding Guidelines, and AHA Coding Clinic to ensure compliance and accuracy. Utilize proprietary auditing systems and various medical records systems to perform audits efficiently and make sound audit determinations. Ensure HIPAA compliance regarding protected health information and participate in exit interviews to summarize audit findings. Qualifications and Experience Requirements National certification as RHIA, RHIT, CCS, or equivalent required. Minimum of five years of experience in hospital inpatient coding for IPPS reimbursement and at least two years performing DRG validation or inpatient claims auditing. Proven experience in clinical documentation integrity and a comprehensive understanding of DRG structure and regulatory requirements. Strong communication skills, with the ability to apply critical review judgment for clinical and coding determinations. Proficiency in using coding software and tools, with experience in remote work and familiarity with Windows office systems. PTO, Paid Holidays, and Volunteer Days. Eligibility for health, vision, and dental coverage, 401(k) plan participation with company match, and flexible spending accounts. Tuition Reimbursement and eligibility for company-paid benefits including life insurance, short?term disability, and parental leave. Remote and hybrid work options. If this role is an ideal fit for you, we want to hear from you. Refactor Talent is committed to connecting top talent with incredible opportunities. We encourage you to send your resume and cover letter to anna@refactortalent.com Seniority level Mid-Senior level Employment type Full-time Job function Information Technology Industries IT Services and IT Consulting and Hospitals and Health Care Referrals increase your chances of interviewing at Refactor Talent by 2x #J-18808-Ljbffr

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