DRG Reviewer - Level 1

MedReview

New York, NY

$85,000 Yearly
Vision , Medical , Dental , Paid Time Off , Retirement
Full-Time

Job Description

Position SummaryAt 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 Coding Department leaders, the Level 1 DRG Reviewer will conduct initial reviews of the claims within the internal CORE application.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 productivity expectations as outlined in the department productivity policy.
Maintains 95% accuracy in claim reviews.
Complies with organization policy and procedures.

Qualifications

Coding Certification required (at least one of the following is required and must be maintained as a condition of employment).
- Registered Health Information Administrator (RHIA)
- Registered Heath Information Technician (RHIT)
- Certified Coding Specialist (CCS)
- Certified Inpatient Coder (CIC)
- Candidates with a Registered Heath Information Technician (RHIT)
- Certified Clinical Documentation Specialist (CCDS), Certified Documentation Improvement Practitioner (CDIP) or Certified Professional Coder (CPC) will be considered but will need to obtain an inpatient coding certification (CCS or CIC) within 12 months of hire.

College level courses in medical terminology, anatomy, pathophysiology, pharmacology, and medical coding courses.
At least 1 year of experience in MS-DRG and APR-DRG coding experience through acute care inpatient coding, auditing, and/or payment integrity DRG Validation.
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.

Benefits and perks include:

Healthcare that fits your needs - We offer excellent medical, dental, and vision plan options that provide coverage to employees and dependents.
401(k) with Employer Match - Join the team and we will invest in your future
Generous Paid Time Off - Accrued PTO starting day one, plus additional days off when you’re not feeling well, to observe holidays.
Wellness - We care about your well-being. From Commuter Benefits to FSAs we’ve got you covered.
Learning & Development - Through continued education/mentorship on the job and our investment in LinkedIn Learning, we’re focused on your growth as a working professional.

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.

Salary: starting at $85k

cIQGGttQ2B