Machinify

5 months ago

DRG Reviewer

✓ Verified Job

Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI

Last checked: 2 hours agoStatus: Live

Job Summary

DRG Reviewer on the Complex Payment Solutions team audits patient records for clinical, coding, and payer guideline alignment to ensure accurate reimbursement. You will document findings, provide evidence-based code rationales, and collaborate on DRG denials, while maintaining HIPAA compliance and aiming for timely, high-quality audits within a healthcare payer context.

Location: United States

Workplace: Remote

Employment Type: Full time

Job Function: Government Affairs & Public Policy

Key Responsibilities

•Audit patient medical records using clinical, coding, and payer guidelines to ensure accurate reimbursement.
•Provide clear, evidence-based rationale for code recommendations or reconsiderations to providers or payers.
•Collaborate with team leaders to ensure thorough review of DRG denials.
•Conduct audits in alignment with organizational quality and timeliness standards.
•Use proprietary auditing systems proficiently to make consistent determinations and generate audit letters.

Pay and Benefits

Salary: USD 90,000 - 115,000 annually

Perks:MedicalDentalVision401kPaid Leave

Key Requirements

•An associate or bachelor’s degree in nursing (active/unrestricted license); or in health information management is required.
•Inpatient claims auditing, quality assurance or recovery auditing experience of 2 years or more required, and/or Inpatient Clinical Documentation Integrity experience of 2 years or more required
•Strong focus on quality and attention to detail.
•Deep curiosity and analytical skills to understand root causes of events and behaviors.
•Proven ability to apply critical judgment in clinical and coding determinations.

Experience:2+ yearsHealthcareHospitalPayerDRGClinical documentation integrity

Education:Bachelor's

Skills:Attention to detailAnalyticalCommunication

Licenses:RHIARHITCDDSCDIPCCDSCCSCIC

Certifications:RHIARHITCDDSCDIPCCSCIC

Languages:English

Tech Stack:ICD-10-CM/PCSDRGUHDDSAHA Coding Clinic Guidelines

Company Brief

Machinify

Industry: Industrial Automation

Website

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Machinify

5 months ago

DRG Reviewer

✓ Verified Job

Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI

Last checked: 2 hours agoStatus: Live

Job Summary

Location: United States

Workplace: Remote

Employment Type: Full time

Job Function: Government Affairs & Public Policy

Key Responsibilities

•Audit patient medical records using clinical, coding, and payer guidelines to ensure accurate reimbursement.
•Provide clear, evidence-based rationale for code recommendations or reconsiderations to providers or payers.
•Collaborate with team leaders to ensure thorough review of DRG denials.
•Conduct audits in alignment with organizational quality and timeliness standards.
•Use proprietary auditing systems proficiently to make consistent determinations and generate audit letters.

Pay and Benefits

Salary: USD 90,000 - 115,000 annually

Perks:MedicalDentalVision401kPaid Leave

Key Requirements

•An associate or bachelor’s degree in nursing (active/unrestricted license); or in health information management is required.
•Inpatient claims auditing, quality assurance or recovery auditing experience of 2 years or more required, and/or Inpatient Clinical Documentation Integrity experience of 2 years or more required
•Strong focus on quality and attention to detail.
•Deep curiosity and analytical skills to understand root causes of events and behaviors.
•Proven ability to apply critical judgment in clinical and coding determinations.

Experience:2+ yearsHealthcareHospitalPayerDRGClinical documentation integrity

Education:Bachelor's

Skills:Attention to detailAnalyticalCommunication

Licenses:RHIARHITCDDSCDIPCCDSCCSCIC

Certifications:RHIARHITCDDSCDIPCCSCIC

Languages:English

Tech Stack:ICD-10-CM/PCSDRGUHDDSAHA Coding Clinic Guidelines

Company Brief

Machinify

Industry: Industrial Automation

Website