Mitchell Martin Inc. · 13 hours ago
DRG Reviewer
United States
Full-time
Remote
Entry, Mid Level
$85K/yr - $105K/yr
2+ years expMitchell Martin Inc. is seeking a DRG Reviewer to perform DRG payment validation and auditing of medical records. The role involves documenting findings and providing clinical support for payment determinations while ensuring compliance with organizational standards.
B2BBookkeeping and PayrollConsultingHealth CareHuman ResourcesInformation TechnologyStaffing Agency
Responsibilities
Responsible for auditing patient medical records using clinical and coding guideline knowledge along with payer requirements to ensure reimbursement accuracy
Provide clear, concise, and compelling rationale and supporting clinical evidence to provider or payer for recommendations or reconsiderations of unsupported billed codes
Collaborate with team leaders to ensure DRG denial is thoroughly reviewed
Perform all audits in observance of organizational quality and timeliness standards set by the audit operations management team
Utilizes proprietary auditing systems and intellectual property with a high level of proficiency to make sound and consistent audit determinations and generate audit letters
Makes recommendations for improvements to the audit system that enhance efficiency
Assures HIPAA compliance for protected health information
Qualification
Required
RHIA, RHIT, CCDS, CDIP, CCS, or CIC Required
Inpatient claims auditing, quality assurance, or recovery auditing experience of 2 years or more required, and/or Inpatient Clinical Documentation Integrity experience of 2 years or more required
Strong focus on quality and attention to detail
Deep curiosity and analytical skills to understand root causes of events and behaviors
Proven ability to apply critical judgment in clinical and coding determinations
In-depth knowledge of clinical criteria and documentation requirements to support code assignments
Expert in DRG methodologies (e.g., MS & APR)
Expertise in ICD-10-CM/PCS coding, UHDDS definitions, Official Coding Guidelines, and AHA's Coding Clinic Guidelines
Ability to work independently and efficiently with minimal supervision
Company
Mitchell Martin Inc.
Mitchell Martin Inc.
501-1000 employees
H1B Sponsorship
Mitchell Martin Inc. has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (99)
2024 (104)
2023 (156)
2022 (122)
2021 (157)
2020 (253)
Funding
Current Stage
Late StageLeadership Team
Anthony Giardina, PMP
Chief Technology Officer
Joseph Schimpf
CFO
Recent News
2025-12-30
Kansas City Business Journal
2024-12-24
2023-01-09
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