What are the responsibilities and job description for the DRG Reviewer- Nashville position at Refactor Talent?
We’re 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.
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.