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DRG

61 jobs near Columbus, OH

MMC Group

DRG Auditor

San Antonio, TX · Remote

DRG Validation Auditors are charged with rendering appropriate, well-supported, and thoroughly-documented decisions, which may result in identification of improper payments (overpayments and ...

Machinify

DRG Manager

As part of the Complex Payment Solutions Team, you will, as the DRG Manager, be responsible for the development and management of our clinical solutions, including MS and APR-DRG validation. This ...

Astrana Health, Inc.

$33 - $38/hr

DRG Coder Department: HS - UM Employment Type: Full Time Location: 600 City Parkway West 10th Floor, Orange, CA 92868 Reporting To: Alice Tejeda Compensation: $33.00 - $38.00 / hour Description The ...

UPMC Senior Communities

DRG Specialist

Pittsburgh, PA · On-site

$27.89 - $48.21/hr

Assists with training of new DRG Specialists and coders as requested. * Focus emphasis of educational communications on accurate and thorough documentation necessary to support the coding of ...

Zelis

Inpatient DRG Reviewer

Atlanta, GA

$79K - $99K/yr

Conduct reviews on inpatient DRG claims as they compare with medical records ICD-10 Official Coding Guidelines, AHA Coding Clinic and client specific coverage policies. Conduct prompt claim review to ...

Jzanus Consulting

DRG Validator- Remote

Garden City, NY · Remote

$85K/yr

The DRG Validation position requires an extensive background in inpatient DRG coding with a deep understanding of the MS-DRG and APR-DRG payment systems. The validator is responsible for auditing ...

Zelis

Inpatient DRG Reviewer

Morristown, NJ

$79K - $99K/yr

Conduct reviews on inpatient DRG claims as they compare with medical records ICD-10 Official Coding Guidelines, AHA Coding Clinic and client specific coverage policies. Conduct prompt claim review to ...

Emory Healthcare

Inpatient DRG Coding Auditor

Atlanta, GA · On-site

$26 - $29.50/hr

Description We are seeking an experienced Inpatient DRG Coding Auditor to extract data from patient encounters ensuring the accuracy of DRGs. This individual will: * Reviews inpatient medical records ...

Zelis

Inpatient DRG Reviewer

Saint Petersburg, FL

$79K - $99K/yr

Conduct reviews on inpatient DRG claims as they compare with medical records ICD-10 Official Coding Guidelines, AHA Coding Clinic and client specific coverage policies. Conduct prompt claim review to ...

Zelis

Inpatient DRG Reviewer

Plano, TX

$79K - $99K/yr

Conduct reviews on inpatient DRG claims as they compare with medical records ICD-10 Official Coding Guidelines, AHA Coding Clinic and client specific coverage policies. Conduct prompt claim review to ...

Zelis

Inpatient DRG Reviewer

Boston, MA

$79K - $99K/yr

Conduct reviews on inpatient DRG claims as they compare with medical records ICD-10 Official Coding Guidelines, AHA Coding Clinic and client specific coverage policies. Conduct prompt claim review to ...

Experis

DRG Auditor

Maplewood, MN

$25 - $30/hr

DRG Auditor Location: Maplewood, MN Pay Range:25-30/hr 8-40 hours a week (As needed basis) Work as needed. What's the Job? * Perform clinical validation and coding of inpatient diagnoses and ...

Emory Healthcare

Inpatient DRG Coding Auditor

Atlanta, GA · On-site

$39.31 - $47.90/hr

We are seeking an experienced Inpatient DRG Coding Auditor to extract data from patient encounters ensuring the accuracy of DRGs. This individual will: * Reviews inpatient medical records for select ...

Emory Healthcare

Inpatient DRG Coding Auditor

Atlanta, GA · On-site

$26 - $29.50/hr

Description We are seeking an experienced Inpatient DRG Coding Auditor to extract data from patient encounters ensuring the accuracy of DRGs. This individual will: * Reviews inpatient medical records ...

Zelis

Inpatient DRG Reviewer

Saint Louis, MO

$79K - $99K/yr

Conduct reviews on inpatient DRG claims as they compare with medical records ICD-10 Official Coding Guidelines, AHA Coding Clinic and client specific coverage policies. Conduct prompt claim review to ...

Emory Healthcare

Inpatient DRG Coding Auditor

Atlanta, GA

$26 - $29.50/hr

Description We are seeking an experienced Inpatient DRG Coding Auditor to extract data from patient encounters ensuring the accuracy of DRGs. This individual will: * Reviews inpatient medical records ...

Zelis

Inpatient DRG Reviewer

Saint Petersburg, FL · On-site

$79K - $99K/yr

Conduct reviews on inpatient DRG claims as they compare with medical records ICD-10 Official Coding Guidelines, AHA Coding Clinic and client specific coverage policies. Conduct prompt claim review to ...

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DRG Auditor

DRG Auditor

MMC Group

San Antonio, TX • Remote

Full-time

Posted 7 days ago

Job description


Job Description:

A leader in providing clinical auditing services to public and commercial healthcare payers throughout the US, has openings for remote DRG Validation Auditors. As members of the DRG Validation Team and working remotely, incumbents will be responsible for reviewing medical records to determine the accuracy of coding and reimbursement for clinical services rendered to beneficiaries of various health plans, including Commercial, Medicare, and Medicaid Clients. DRG Validation Auditors are charged with rendering appropriate, well-supported, and thoroughly-documented decisions, which may result in identification of improper payments (overpayments and underpayments) on paid claims on behalf of the client from various providers of clinical services, including but not limited to acute care, long-term acute care, acute rehabilitation, and skilled nursing facilities, as well as other provider types and care settings. Initially, DRG Validation Auditors are prepared for the role through a detailed, well-defined training process, gaining knowledge and skills in methods for review of medical records and other provider documentation. Ongoing training and education are provided specific to audit processes, coding and reimbursement changes, and other topics as well. The DRG Validation Auditor reports to a DRG Validation Team Leader, who provides support, feedback, and guidance to DRG Validation Auditors. Moreover, quality assurance is provided through a well-defined review and quality management program performed by the Professional Development Team.


Specifically, DRG Validation Auditors will be responsible for the following:


  • Review inpatient medical records to validate the admit order, assignment and sequencing of ICD9-CM diagnosis and procedure codes, discharge status codes, and DRG assignment.

  • Provide a detailed rationale for every medical record review resulting in a DRG Review Results letter, including supporting references.

  • Follow proper procedure for referral to Clinical Nurse Auditor or Physician Advisor.

  • Utilize proper reference material, standards, and guidelines for coding.

  • Provide input to the Edit Development team on claims selection criteria.

  • Verify data received from client and work to resolve discrepancies.

  • If the contract requires onsite review, interact with Providers and other personnel in a professional manner.

  • Follow policies and processes

  • Comply with department standards regarding productivity and audit quality.

  • Perform other duties as assigned.



To be considered for these challenging roles, applicants must have a majority of the following skills, knowledge and abilities:


  • Possess current AHIMA credentials (RHIT/RHIA/CCS), with current CCS preferred

  • Demonstrate extensive knowledge of ICD-9-CM coding and DRG reimbursement, with a minimum of five years of inpatient coding experience

  • Have an understanding of Medicare, Medicaid, and commercial provider reimbursement methodologies, and possess strong data analysis skills

  • Working knowledge of computer functions and applications such as Microsoft Office (Outlook, Word, Excel) and Windows operating systems

  • Ability to write a well-reasoned review in a narrative style, with accurate spelling, grammar, punctuation, and sentence structure

  • Ability to adapt to changing priorities in order to meet Client requirements and productivity standards and deadlines

  • Ability to travel for additional training and on-site reviews on an as-needed basis

  • Since incumbents will work from their home-based offices, they must have their own access to high-speed Internet connectivity