DRG Reviewer
ZelisHyderabad, Telangana, India
Posted May 6, 2026
Full Time
About the Company
Zelis modernizes the healthcare financial experience in the U.S. across payers, providers, and healthcare consumers.
Job Description
Zelis is looking for a DRG Reviewer to conduct post-service, pre-payment and post pay comprehensive inpatient DRG reviews based on industry standard inpatient coding guidelines and rules, evidence based clinical criteria plan, and policy exclusions. The ideal candidate should have strong expertise in DRG, inpatient coding certification, and 3-5 years of reviewing and/or auditing ICD-10 CM, MS-DRG and APR-DRG claims.
Requirements
- Registered Nurse licensure preferred
- Graduate
- Inpatient Coding Certification (CCS, CIC, RHIA, RHIT)
- 3-5 years reviewing and/or auditing ICD-10 CM, MS-DRG and APR-DRG claims
- Solid understanding of audit techniques, identification of revenue opportunities and financial negotiation with providers
- Experience and working knowledge of Health Insurance, Medicare guidelines and various healthcare programs
- Understanding of hospital coding and billing rules
- Clinical skills to evaluate appropriate Medical Record Coding
- Experience conducting root cause analysis and identifying solutions
- Strong organization skills with attention to detail
- Outstanding verbal and written communication skills
Benefits
- Comprehensive healthcare benefits
- Financial wellness programs
- Cultural celebrations