California Licensed DRG Reviewer

A company is looking for a DRG Reviewer. Key Responsibilities Audit patient medical records using clinical, coding, and payer guidelines to ensure accurate reimbursement Provide clear, evidence-based rationale for code recommendations or reconsiderations to providers or payers Collaborate with team leaders to ensure thorough review of DRG denials Required Qualifications An associate or bachelor's degree in nursing or health information management, or equivalent work experience At least one relevant certification (e.g., RHIA, RHIT, CCDS, CDIP, CCS, CIC) is required Minimum of 2 years of experience in inpatient claims auditing or clinical documentation integrity In-depth knowledge of clinical criteria, documentation requirements, and DRG methodologies Expertise in ICD-10-CM/PCS coding and related guidelines

Mar 25, 2025 - 17:37

A company is looking for a DRG Reviewer. Key Responsibilities Audit patient medical records using clinical, coding, and payer guidelines to ensure accurate reimbursement Provide clear, evidence-based rationale for code recommendations or reconsiderations to providers or payers Collaborate with team leaders to ensure thorough review of DRG denials Required Qualifications An associate or bachelor's degree in nursing or health information management, or equivalent work experience At least one relevant certification (e.g., RHIA, RHIT, CCDS, CDIP, CCS, CIC) is required Minimum of 2 years of experience in inpatient claims auditing or clinical documentation integrity In-depth knowledge of clinical criteria, documentation requirements, and DRG methodologies Expertise in ICD-10-CM/PCS coding and related guidelines