Inpatient DRG Reviewer
Core
Conduct post-service, pre-payment, and post-pay comprehensive inpatient DRG reviews to validate billed DRGs against medical records and coding guidelines, determine revised codes, and write customer-facing rationale for changes.
Role type
Inpatient DRG Reviewer (Clinical Coding & Auditing)
Builds
Accurate MS-DRG/APPR-DRG claims and readmission compliance reports for healthcare payers.
Domain
Healthcare Payer / Medical Coding & Billing
Required skills
Inpatient coding certification (CCS/CIC), ICD-10 CM knowledge, MS-DRG/APPR-DRG expertise, readmission review analysis, clinical evidence evaluation, medical record auditing, root cause analysis
Preferred skills
RN or LVN licensure, 1-3 years auditing experience, Medicare guidelines knowledge, hospital billing rules understanding, communication skills
Technologies
ICD-10 Official Coding Guidelines, AHA Coding Clinic, proprietary claim review software
