As an Inpatient DRG Reviewer at Zelis, you will conduct comprehensive inpatient DRG validation reviews, perform readmission reviews, and identify new DRG coding concepts to expand the DRG product.
Requirements
- RN or LVN required
- Inpatient Coding Certification required (CCS, CIC) within 4 – 6 months of hire date
- 1 -3 years reviewing and or auditing ICD-10 CM, MS-DRG and APPR-DRG claims preferred
- Experience and working knowledge of Health Insurance, Medicare guidelines and various healthcare programs
- Experience performing readmission reviews, including evaluating relatedness, preventability, and compliance with readmission policies
- 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
- 401k plan with employer match
- Flexible paid time off
- Holidays
- Parental leaves
- Life and disability insurance
- Health benefits including medical, dental, vision, and prescription drug coverage