DRG Reviewer

🔥 1 minute ago

🇺🇸 United States – Remote

💵 $85k - $95k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 2%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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MedReview Inc.

WebsiteLinkedInAll Job Openings

201 - 500 employees

🏥 Healthcare

⚕️ Healthcare Insurance

💸 Finance

Healthcare • Healthcare Insurance • Finance

MedReview Inc. is a leading provider of advanced payment integrity solutions, specializing in healthcare claims. They work with a wide range of clients, including health plans, government agencies, and payors, to reduce unnecessary waste and save billions of dollars. Their team of highly trained physicians, registered nurses, and certified coders conduct thorough clinical and coding reviews to identify inaccuracies in healthcare claims. MedReview employs proprietary algorithms to analyze complex data and detect suspicious payment trends, offering a unique blend of clinical expertise and advanced technology to maximize efficiencies and improve healthcare cost management.

📋 Description

• Review and analyze inpatient medical records and claims to validate ICD-10-CM/PCS coding accuracy and appropriate DRG assignment • Apply Official Coding Guidelines, AHA Coding Clinic guidance, CMS regulations, and industry standards during claim reviews • Identify coding discrepancies, documentation concerns, and reimbursement opportunities • Ensure accurate application of MS-DRG and APR-DRG methodologies • Evaluate claims for potential payment integrity findings and support accurate reimbursement outcomes • Identify cases requiring additional clinical review and collaborate with Physician Reviewers • Interpret complex clinical documentation and coding scenarios • Support interdisciplinary review processes and maintain compliance with organizational, regulatory, and client-specific requirements • Complete comprehensive claim reviews according to departmental procedures and review guidelines • Maintain productivity and quality benchmarks and complete reviews within required turnaround times • Participate in quality monitoring and continuous improvement initiatives • Document findings, rationales, and recommendations clearly and accurately • Maintain detailed review records and submit productivity and performance reporting • Adhere to confidentiality, HIPAA, and data security requirements • Participate in departmental meetings, training sessions, and educational activities • Stay current with coding updates, regulatory changes, and industry best practices • Maintain required certifications and continuing education requirements • Support special projects and additional responsibilities as assigned • Contribute to savings identification and reimbursement accuracy initiatives

🎯 Requirements

• Current coding certification in one or more of the following: Certified Coding Specialist (CCS), Certified Inpatient Coder (CIC), or Registered Health Information Technician (RHIT) • Minimum of 3 years of experience in acute inpatient coding, DRG validation, coding audits, or payment integrity review • Strong knowledge of ICD-10-CM/PCS coding guidelines and DRG methodologies • Experience applying Official Coding Guidelines, AHA Coding Clinic guidance, CMS regulations, and reimbursement policies • Proficiency with Microsoft Office applications, including Outlook, Word, and Excel • Strong analytical, organizational, and critical thinking skills • Excellent written and verbal communication abilities • Ability to work independently and efficiently manage multiple priorities in a remote environment • High-speed internet connection (100 Mbps recommended) • Secure workspace that protects confidential and HIPAA-regulated information • Ability to work independently in a distraction-free environment • Ability to sit and work at a computer for extended periods of time • Availability during Eastern Standard Time (EST) business hours • Must currently reside in the United States and be authorized to work for any employer in the U.S. without current or future visa sponsorship • Bachelor's degree in Health Information Management, Healthcare Administration, Nursing, or a related field (preferred) • Experience in payment integrity, DRG auditing, or healthcare claims review (preferred) • Experience with both MS-DRG and APR-DRG validation (preferred) • Knowledge of payer reimbursement methodologies and claims operations (preferred) • Previous experience working remotely in a healthcare review environment (preferred)

🏖️ Benefits

• Comprehensive Medical, Dental, and Vision Coverage • 401(k) with Employer Match • Generous Paid Time Off and Paid Holidays • Flexible Spending Accounts (FSA) and Commuter Benefits • Professional Development and Continuing Education Support • LinkedIn Learning Access and Ongoing Training Programs • Employee Wellness Programs • Collaborative and Mission-Driven Work Environment

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