As an Inpatient DRG Sr. Reviewer at Zelis, you will conduct comprehensive inpatient DRG validation Quality Assurance reviews to determine accuracy of the DRG billed, based on industry standard coding guidelines and the clinical evidence supplied by the provider in the form of medical records. The role requires a unique blend of personality and professional expertise, inspiring others with your passion and dedication.
Requirements
- Registered Nurse licensure preferred
- Inpatient Coding Certification required (i.e., CCS, CIC, RHIA, RHIT)
- 5+ years reviewing and/or auditing ICD-10 CM, MS-DRG and APR-DRG claims preferred
- 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
- Strong understanding of hospital coding and billing rules
- Clinical and critical thinking skills to evaluate appropriate coding
- Strong organization skills with attention to detail
- Excellent communication skills both verbal and written, and skilled at developing and maintaining effective working relationships.
- Demonstrated thought leadership and motivation skills, a self-starter with an ability to research and resolve issues
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
