DRG Specialist

2 weeks ago

Tampa, Florida, United States Apixio Full time

At Apixio, we are revolutionizing healthcare by creating a leading Connected Care platform to minimize reimbursement inaccuracies and high-quality patient care.

Salary

$85,000—$105,000 USD per year, with opportunities for variable compensation and exceptional benefits.

Job Description

We are seeking an experienced DRG Reviewer to perform DRG payment validation reviews of medical records and provide clinical/policy/regulatory support for payment determination.

This role involves auditing patient medical records using clinical and coding guideline knowledge along with payer requirements to ensure reimbursement accuracy.

  • Audit patient medical records using clinical and coding guideline knowledge.
  • Provide clear, concise, and compelling rationale and supporting clinical evidence for recommendations or reconsiderations of unsupported billed codes.
  • Collaborate with team leaders to ensure thorough review of DRG denial.
  • Perform audits in observance of organizational quality and timeliness standards.
Required Skills and Qualifications

To be successful in this role, you will need:

  • An associate or bachelor's degree in nursing (active/unrestricted license), health information management, or relevant work experience.
  • At least one of the following certifications: RHIA, RHIT, CCDS, CDIP, CCS, CPC-H, CIC.
  • Inpatient claims auditing, quality assurance, or recovery auditing experience of 2 years or more.
  • Subject matter expertise in DRG methodologies, ICD-10-CM/PCS coding methodologies, UHDDS definitions, Official Coding Guidelines, and AHA's Coding Clinic Guidelines.
Benefits

We offer a competitive compensation package, including:

  • Base salary $85,000—$105,000 USD per year.
  • Exceptional benefits, including medical, dental, and vision coverage.
  • FSA/HSA options.
  • Generous vacation policy.

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