DRG Reviewer
ZelisHyderabad, Telangana, India
Posted May 25, 2026
Full Time
About the Company
Zelis is a healthcare technology company that modernizes the healthcare financial experience in the US.
Job Description
Zelis is a healthcare technology company that modernizes the healthcare financial experience in the US. We are looking for a DRG Reviewer to conduct comprehensive inpatient DRG validation reviews based on industry standard coding guidelines and clinical evidence. The ideal candidate should have strong expertise in DRG, including inpatient coding certification and 3-5 years of experience reviewing and/or auditing ICD-10 CM, MS-DRG, and APR-DRG claims.
Requirements
- Registered Nurse licensure preferred
- Inpatient Coding Certification required (i.e., 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
- Hybrid work flexibility
- Comprehensive healthcare benefits
- Financial wellness programs
- Cultural celebrations