DRG Reviewer

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MedReview Inc.

WebsiteLinkedInAll Job Openings

201 - 500 employees

⚕️ Healthcare Insurance

💸 Finance

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

• Analyze and review inpatient claims following the Official Coding and Reporting Guidelines to validate the reported ICD-10-CM/PCS codes to ensure proper DRG assignment for accurate billing. • Demonstrates the ability to perform a comprehensive initial review as outlined in the standard operating procedures and departmental guides. • Collaborates with physician reviewers, as needed. • Ability to prioritize and organize workload and complete tasks independently. • Required attendance of all departmental team meetings and/or training. • Work on other duties or tasks, as necessary. • Report productivity daily utilizing department productivity report. • Meet/exceed daily productivity expectations. • Maintains 95% accuracy in claim reviews. • Must be available to work a 7.5-hour workday during Eastern Standard Time (EST) business hours. • Comply with organization policy and procedures.

🎯 Requirements

• Coding Certification required (at least one of the following is required and must be maintained as a condition of employment). • Certified Coding Specialist (CCS) • Certified Inpatient Coder (CIC) • Registered Heath Information Technician (RHIT) • College level courses in medical terminology, anatomy, pathophysiology, pharmacology, and medical coding courses. • At least 3 years’ experience in MS-DRG and APR-DRG validation in acute care inpatient coding, auditing. • Payment integrity DRG validation is a plus. • Adherence to the Official Coding and Reporting guidelines, AHA Coding Clinic determinations, and CMS and other regulatory compliance guidelines and mandates. • Requires working knowledge of applicable industry-based standards. • Proficiency in Outlook, Word, Excel, and other applications. • Excellent written and verbal communication skills. • Maintain professional credentialed status with approved continuing education programs. • Ability to work independently and can multi-task or transition to different tasks easily.

🏖️ Benefits

• Healthcare that fits your needs - We offer excellent medical, dental, and vision plan options that provide coverage to employees and dependents. • 401(k) with Employer Match - Join the team and we will invest in your future • Generous Paid Time Off - Accrued PTO starting day one, plus additional days off when you’re not feeling well, to observe holidays. • Wellness - We care about your well-being. From Commuter Benefits to FSAs we’ve got you covered. • Learning & Development - Through continued education/mentorship on the job and our investment in LinkedIn Learning, we’re focused on your growth as a working professional.