DRG Reviewer (Onsite - Hendersonville, TN)

The role

The DRG Reviewer provides MS-DRG and APR-DRG audit services at provider locations. This role involves examining medical records to validate accuracy of billing and DRG assignments.

What you will do

• Audit patient medical records using clinical and coding guideline knowledge.
• Provide written rationale and clinical evidence for recommendations.
• Collaborate with team leaders to ensure DRG denial is reviewed.
• Maintain expert knowledge of ICD-10-CM/PCS coding conventions and rules.
• Perform audits following organizational quality and timeliness standards.
• Use proprietary auditing systems and medical records systems.
• Ensure HIPAA compliance for protected health information.
• Participate in exit interviews with the client summarizing audit findings.
• Abide by the Standards of Ethical Coding.
• Other duties as assigned.

Required qualifications

• National certification as RHIA, RHIT, and/or CCS.
• Associate or bachelor's degree in nursing (active/unrestricted license) or health information management, or work experience in lieu of formal education.
• At least one of the following: RHIA, RHIT, CCDS, CDIP, CCS, CPC-H, or CIC.
• 2 or more years of inpatient claims auditing, quality assurance or recovery auditing experience.
• 2 or more years of inpatient Clinical Documentation Integrity experience.
• Knowledge of DRG structure and regulatory requirements.
• Knowledge of ICD-10-CM/PCS coding methodologies, UHDDS definitions, Official Coding Guidelines and AHA's Coding Clinic Guidelines.
• Experience working with laptops and multiple monitors.
• Experience working remotely.
• Working knowledge of Windows office systems including full Microsoft Suite and Teams.
• Experience with Encoder/Grouper programs (TruCode/3M) and/or similar coding and auditing tools.
• Ability to sit or stand for long periods, occasional stooping, and reaching.

Nice to have

• Previous auditing/ recovery experience preferred.
• Highly recommend ICD-10 specialized training.

Benefits

• Top Medical/Dental/Vision offerings
• FSA/HSA
• Tuition reimbursement
• Competitive salary
• 401(k) with company match
• PTO
• Additional health and wellness benefits and perks
• Meaningful equity

About the company

Machinify is a healthcare intelligence company that delivers value, transparency, and efficiency to health plan clients. It uses an AI-powered platform and expertise to maximize financial outcomes and drive down healthcare costs.