Drg Reviewer

Centene

Base: $70,100.00 - $126,200.00 py; bonus/equity: n...
Hybrid
Ms-drg and apr-drg coding expertise
Icd-10-cm/pcs coding proficiency
Inpatient hospital reimbursement rules
The role involves independently conducting comprehensive reviews of MS-DRG and APR-DRG coding to ensure accurate reimbursement for 28 million members

Job Summary

  • The role involves independently conducting comprehensive reviews of MS-DRG and APR-DRG coding to ensure accurate reimbursement for 28 million members.
  • Candidates must exercise professional judgment to validate diagnosis code assignments and identify discrepancies such as upcoding or coding errors.
  • Centene offers a competitive benefits package including health insurance, 401K, stock purchase plans, and flexible work schedules.

Matching Summary

The role involves independently conducting comprehensive reviews of MS-DRG and APR-DRG coding to ensure accurate reimbursement for 28 million members.

Salary

Base: $70,100.00 - $126,200.00 per year; Bonus/Equity: Not specified; Benefits: Competitive pay, health insurance, 401K, stock purchase plans, tuition reimbursement, paid time off

Skills & Requirements

Must-have

  • MS-DRG and APR-DRG coding expertise
  • ICD-10-CM/PCS coding proficiency
  • Inpatient hospital reimbursement rules
  • Clinical documentation validation skills
  • DRG encoder/grouper software usage

Nice-to-have

  • Proactive identification of audit opportunities
  • Development of medical policy guidelines
  • Collaboration with Medical Directors
  • Strategic initiative contribution

Key Requirements

  • Associate's Degree in Health Information Management or Nursing
  • 4+ years experience performing MS-DRG and APR-DRG coding
  • 2+ years experience in DRG reviews for Payment Integrity vendor or Payer
  • RHIT, RHIA, CCS, CICP, CCDS, or RN license required
  • Experience with TruCode, 3M, Optum Encoder, Webstrat, or similar tools

Work Rights

Not specified

Tailored Resume

Cover Letter