Inpatient DRG Reviewer

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