Description
At MedReview, our mission is to bring accuracy, accountability, and clinical excellence to healthcare. As such, we are a leading authority in payment integrity solutions including DRG Validation, Cost Outlier and Readmission reviews.
Under the direction of the DRG Operations Department leaders, the DRG Reviewer will conduct reviews of inpatient claims for both coding accuracy as well as perform screening referrals for clinical support of coded diagnoses.
Responsibilities:
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.
Performance Expectations:
Report productivity daily utilizing department productivity report.
Meet/exceed daily productivity expectations.
Maintains 95% accuracy in claim reviews.
Required to work a 7.5-hour workday within the company’s core 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.
Remote Work Requirements:
High speed internet (100 Mbps per person recommended) with secured WIFI.
A dedicated workspace with minimal interruptions to protect PHI and HIPAA information.
Must be able to sit and use a computer keyboard for extended periods of time.
