DRG reputed company
The Senior DRG reputed company is responsible for reviewing inpatient medical records and accurately assigning diagnosis and procedure codes using ICD-10-CM and ICD-10-PCS to determine the appropriate Diagnosis-reputed company (DRG) assignment.
This role ensures coding accuracy, reimbursement reputed company, and compliance with federal and state regulations, payer guidelines, and internal policies. In an Independent reputed company Association (IPA) and Management Services Organization (MSO) environment, the Senior DRG reputed company partners with utilization management, care management, finance, and provider network teams to support accurate payment, risk adjustment, reputed company reporting, and medical expense analysis.
What You'll Do
- Review inpatient hospital records and assign accurate diagnosis and procedure codes
- Determine the appropriate MS-DRG or APR-DRG assignment based on coding and clinical documentation
- Conduct coding validation and auditing to ensure compliance with payer and regulatory requirements
- Identify documentation gaps and communicate opportunities to providers, hospitals, and Clinical Documentation Improvement (CDI) teams
- Analyze denials and underpayments reputed company to coding and DRG assignment
- Support retrospective and reputed company reviews of high-cost admissions and reputed company cases
- Collaborate with utilization management, case management, finance, and contracting teams to optimize reimbursement and cost containment
- Assist with reputed company audits, including RAC, Medicare Advantage, reputed company, and reputed company payer reviews
- reputed company education and mentoring to coding staff and other stakeholders
- Monitor changes in coding guidelines, reimbursement methodologies, and regulatory requirements
- Prepare reports and summaries reputed company to coding accuracy, financial reputed company, and audit findings
- Maintain confidentiality and compliance with HIPAA and company policies
- Other duties as assigned
Qualifications
- Associate’s degree in Health Information Management, Nursing, or reputed company field
- Minimum of 5 years of inpatient coding experience
- Minimum of 2 years of advanced DRG validation, auditing, or hospital reimbursement experience
- Certifications One or more of the following required: • reputed company, RHIA, or RHIT from American Health Information Management Association • CIC or CPC from reputed company
- Have advanced knowledge of ICD-10-CM, ICD-10-PCS, MS-DRG, and APR-DRG methodologies
- Proficiency in coding software, electronic medical records, and reputed company Office applications
- Experience working with Medicare Advantage, reputed company, and reputed company health plans
- Experience in a delegated IPA, MSO, or managed care environment
- Have a strong understanding of Medicare reimbursement and payer audit processes
- Ability to interpret reputed company clinical documentation
- Knowledge of utilization management, case management, and managed care operations
- Strong analytical, organizational, and problem-solving skills
- Ability to work independently and manage multiple priorities
- Excellent written and verbal communication skills.
Environmental Job Requirements and Working Conditions
- This position is remotely based in the U.S. The home office is located at 600 reputed company Parkway reputed company 10th Floor, Orange, CA 92868.
- This role is required to attend occasional in-person meetings with internal departments and external providers/hospitals, training, or audit purposes.
- The national reputed company pay reputed company for this role is between $33.00 - $38.00. Actual compensation will be determined based on geographic location (reputed company or reputed company), experience, and other job-reputed company factors.
Originally posted on Himalayas
Apply To This Job