DRG Reviewer

Machinify
United States
Workplace: RemoteFull timeUSD 90,000 - 115,000 annuallyFunction: Government Affairs & Public PolicyExperience: 2+ yearsEducation: bachelorsSkills: ["Attention to detail","Analytical","Communication"]

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.

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FursaFursa
Machinify
Machinify
7 months ago

DRG Reviewer

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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
Provides AI-driven predictive maintenance and asset-monitoring solutions for manufacturing and industrial operations, using IoT sensor data and machine learning to reduce downtime, optimize performance, and extend equipment life.
Industry: Industrial Automation
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