State Licensed DRG Dispute Reviewer
virtual vocationsDenver, CO
State Licensed DRG Dispute Reviewer
Occupations
Healthcare Diagnosing or Treating Practitioners, All OtherHealth Information Technologists and Medical RegistrarsArbitrators, Mediators, and ConciliatorsIndustries
General Medical and Surgical HospitalsAll Other Miscellaneous Ambulatory Health Care ServicesSpecialty HospitalsAbout the role
Evaluating provider appeals and original audit findings, the remote State Licensed DRG Dispute Reviewer will determine correct DRG assignments and payment outcomes, ensuring compliance and accuracy in documentation and reimbursement practices.
Key responsibilities:
Evaluate provider-submitted appeals and original audit findings to validate or revise DRG determinations
Review inpatient medical records and documentation for correct DRG assignment and adherence to coding guidelines
Prepare clear, evidence-based rationales to support determinations for clients, providers, or payers
Required qualifications:
An associate or bachelor's degree in nursing or health information management, or equivalent work experience
At least one relevant certification: RHIA, RHIT, CCS, CIC, CDIP, or CCDS
Minimum 3 years of inpatient hospital coding experience
Minimum 4 years of DRG validation experience, with a preference for dispute review and recovery audits
Expert-level knowledge of ICD-10-CM/PCS coding systems and MS-DRG/APR-DRG methodologies
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JOB OVERVIEW
Experience level
Senior
Location
Denver, CO
Occupation
Healthcare Diagnosing or Treating Practitioners, All Other
Industry
General Medical and Surgical Hospitals
Posted
yesterday
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