What are the responsibilities and job description for the DRG Reviewer position at Refactor Talent?
We’re seeking to connect a DRG Reviewer with a leading company in the healthcare industry on a full-time basis. The role is fully remote and allows you to work one continuous shift of 8 hours (with breaks) between 6am - 6pm EST. As a DRG Reviewer, you will have the opportunity to join a passionate, motivated team and leverage your expertise in clinical guidelines and coding protocols.
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.
- Conduct audits in alignment with organizational quality and timeliness standards.
- Use proprietary auditing systems proficiently to make consistent determinations and generate audit letters.
- Recommend improvements to the audit system to enhance efficiency.
- Ensure compliance with HIPAA regulations for protected health information.
- Perform other duties as assigned.
Qualifications:
- Minimum of 5 years of experience in inpatient focused coding and Clinical Documentation.
- Technical experience with encoder software and profit recovery expertise.
- An associate or bachelor’s degree in nursing (active/unrestricted license) or in health information management is required.
- Certification in at least one of the following: RHIA, RHIT, CCDS, CDIP, CCS, or CIC. Jump on the fast track for CCS or CDIP!
- Strong focus on quality and attention to detail.
- Proven ability to apply critical judgment in clinical and coding determinations.
- In-depth knowledge of clinical criteria and documentation requirements to support code assignments.
- Expertise in DRG methodologies like MS and APR and ICD-10-CM/PCS coding.
Expected Pay and Benefits:
- Medical, Dental, and Vision insurance
- 401(k) program
- Anticipated salary range: $85,000 - $105,000 USD
If this role is an ideal fit for you, we want to hear from you. Refactor Talent is committed to connecting top talent with incredible opportunities. We would like to help you succeed as you navigate your career search. Apply now so that we can take these next steps together.
Salary : $85,000 - $105,000