Refactor Talent · 3 months ago
DRG Reviewer- Nashville
Nashville , Tennessee
Full-time
Onsite
Mid, Senior Level
$90K/yr - $90K/yr
5+ years expRefactor Talent is seeking to connect an DRG Reviewer with a leading healthcare company in Nashville, TN, on a full-time basis. This role involves providing MS-DRG and APR-DRG audit services at provider locations to ensure accurate reimbursement and compliance.
E-LearningHuman ResourcesRecruitingStaffing Agency
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
Qualification
Required
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
Benefits
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.
Company
Refactor Talent
Refactor Talent is a staffing and recruiting firm that provides enhancement courses, and learning and development programs.
11-50 employees
Funding
Current Stage
Early StageLeadership Team
Richard Myers
Co-Founder
Abigail Petersen
Client Partner
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