Machinify, a leading healthcare intelligence company, is seeking a remote DRG Reviewer to conduct thorough payment validation reviews and ensure compliance with coding and regulatory standards. The ideal candidate will have experience in inpatient claims auditing or clinical documentation, along with relevant certifications
Job Summary
Conduct thorough DRG payment validation reviews, including clinical and coding assessments, of medical records and related documentation in accordance with contract-specific review criteria.
Audit patient medical records using clinical, coding, and payer guidelines to ensure accurate reimbursement and provide clear, evidence-based rationale for code recommendations.
Ensure compliance with HIPAA regulations for protected health information and use proprietary auditing systems proficiently to make consistent determinations.
Matching Summary
Match Score: 85
Machinify, a leading healthcare intelligence company, is seeking a remote DRG Reviewer to conduct thorough payment validation reviews and ensure compliance with coding and regulatory standards. The ideal candidate will have experience in inpatient claims auditing or clinical documentation, along with relevant certifications.
Skills & Requirements
Must-have
DRG payment validation
clinical and coding assessments
medical record review
HIPAA compliance
Nice-to-have
AI-powered platform expertise
disruptively simple solutions
drive down healthcare costs
Key Requirements
Associate or bachelor's degree in nursing (active/unrestricted license) or health information management
RHIA, RHIT, CCDS, CDIP, CCS, or CIC certification
2+ years of inpatient claims auditing, quality assurance, or recovery auditing experience
2+ years of inpatient clinical documentation integrity experience
Expert in DRG methodologies (MS & APR)
Expertise in ICD-10-CM/PCS coding, UHDDS, Official Coding Guidelines, AHA's Coding Clinic