Position Summary

MedReview is an audit and medical management firm specializing in payment integrity, quality assurance and utilization management. With data-rich algorithms to identify claims inaccuracies with remarkable speed and accuracy, our physician-led payment integrity team consistently saves our clients millions of dollars each year.

Our coders start the review process by identifying and analyzing claims, while our board-certified physicians manage the clinical reviews and approve all denials. The savings identified by MedReview allows our clients to apply more resources to patient care while reducing waste. We are currently seeking experienced and highly qualified coding operations professionals to serve as a DRG Validator. This role involves using the latest technology in our approach to chart reviews that encompass coding guidelines and clinical evaluation with a goal towards eliminating unjustified overpayments.

Come grow with us in the rapidly expanding industry of payment integrity! MedReview has been an industry leader for more than 40 years, and we are growing our Coder Team are hiring coders as all experience levels. If you are interested in making the healthcare system more transparent, equitable and accessible to all Americans, MedReview is the right fit for you.

Qualifications/Responsibilities

• Required qualifications, Registered Heath Information Technician (RHIT), Registered Health Information Administrator (RHIA) or Certified Coding Specialist (CCS), or RN with above Coding Certifications a plus.
• Preferred, minimum of 3 years of experience in MS-DRG and APR-DRG Validation.
• Able to work closely with physicians.
• Ability to communicate effectively both orally and in writing.
• Knowledge of computer software programs and able to demonstrate computer skills.
• Ability to prioritize and organize workload and complete tasks independently.
• Ability to justify decisions both in writing and verbally.
• Validate ICD-10-CM/PCS coding to ensure proper DRG assignment for accurate billing.
• Validate clinical indicators for diagnoses that affect the DRG.
• Refer cases to physicians where the diagnosis does not meet the clinical criteria.
• Process issues resulting from a case review and report daily and weekly output.
• Maintain qualitative and quantitative standards designated by the review process.
• Record review decisions and justifications for changes requested or issues raised.
• Inform review staff of applicable coding guidelines to ensure quality DRG reviews.
• Maintain professional credentialed status with approved continuing education programs.