Refactor Talent · 3 months ago
DRG Reviewer
United States
Full-time
Remote
Mid, Senior Level
$85K/yr - $105K/yr
5+ years expRefactor Talent is seeking to connect a DRG Reviewer with a leading company in the healthcare industry. The role involves auditing patient medical records and ensuring compliance with clinical guidelines and coding protocols.
E-LearningHuman ResourcesRecruitingStaffing Agency
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
Qualification
Required
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
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
Benefits
Medical, Dental, and Vision insurance
401(k) program
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
Company data provided by crunchbase