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Machinifyinc is seeking a DRG Dispute Reviewer to evaluate provider appeals and audit findings related to DRG assignments and payment outcomes. The ideal candidate will have a strong background in clinical validation, coding guidelines, and payer policies, along with relevant certifications and experience in inpatient hospital coding.
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Job Summary
The role involves evaluating provider appeals and original audit findings to determine correct DRG assignment and payment outcomes.
Candidates must apply advanced knowledge of MS-DRG and APR-DRG methodologies along with clinical validation principles.
This position plays a vital role in supporting regulatory compliance, identifying overpayments, and promoting proper reimbursement practices.
Matching Summary
Match Score: 75
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Machinifyinc is seeking a DRG Dispute Reviewer to evaluate provider appeals and audit findings related to DRG assignments and payment outcomes. The ideal candidate will have a strong background in clinical validation, coding guidelines, and payer policies, along with relevant certifications and experience in inpatient hospital coding.
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Skills & Requirements
Must-have
MS-DRG and APR-DRG methodology knowledge
Inpatient medical record analysis skills
ICD-10-CM/PCS coding guideline expertise
Clinical validation and judgment capabilities
HIPAA compliance adherence
Nice-to-have
Client meeting presentation experience
Proprietary audit platform proficiency
Strong written justification skills
Team collaboration in dispute resolution
Key Requirements
Associate or bachelor's degree in nursing or HIM
Active/unrestricted nursing license or RHIA/RHIT certification
Minimum 3 years inpatient hospital coding experience