Inpatient DRG Reviewer
IndiaFull-TimeMiddle
Salary not disclosed
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Job Details
- Experience
- 5+ years
- Required Skills
- Quality Assurance
Requirements
- Registered Nurse qualification preferred with active clinical experience.
- Certification in inpatient coding required (e.g., CCS, CIC, RHIA, RHIT).
- 5+ years of experience in DRG review, ICD-10-CM coding, MS-DRG, or APR-DRG auditing in a healthcare or payer environment.
- Strong understanding of hospital billing structures, Medicare guidelines, and healthcare reimbursement systems.
- Solid clinical judgment with the ability to interpret complex medical documentation and apply coding rules accurately.
- Excellent analytical, critical thinking, and problem-solving skills.
- Strong attention to detail with high accuracy in documentation review and data interpretation.
- Effective communication skills with the ability to collaborate across teams and explain coding decisions clearly.
- Self-motivated professional with the ability to work independently in a structured, compliance-driven environment.
- Strong organizational skills and ability to manage multiple cases while meeting strict deadlines.
Responsibilities
- Conduct comprehensive inpatient DRG validation and quality assurance reviews to assess coding accuracy based on ICD-10 guidelines, AHA Coding Clinic standards, and medical documentation.
- Analyze clinical records such as physician notes, lab results, imaging reports, and other supporting evidence to validate assigned DRGs and identify discrepancies.
- Manage assigned claims end-to-end while adhering to turnaround time requirements, client guidelines, and internal standard operating procedures.
- Participate in pre-payment, post-service, and post-pay audit processes to identify revenue integrity opportunities and ensure accurate reimbursement outcomes.
- Serve as a subject matter expert on DRG coding and validation, supporting internal teams with guidance and issue resolution.
- Contribute to quality assurance programs, training initiatives, and onboarding of new team members.
- Identify process gaps and recommend improvements to enhance efficiency, accuracy, and compliance within coding operations.
- Maintain strict adherence to privacy, regulatory, and organizational standards in all review activities.
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