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This position is posted by Jobgether on behalf of a partner company. We are currently looking for an Inpatient DRG Reviewer in India.
This role plays a key part in ensuring the accuracy and integrity of inpatient hospital claims through detailed DRG validation and coding review. You will analyze complex medical records and clinical documentation to verify correct MS-DRG and APR-DRG assignments in alignment with ICD-10 coding standards and payer-specific policies. The position operates at the intersection of clinical expertise and healthcare finance, directly contributing to cost optimization and claim accuracy. You will work on pre- and post-payment reviews that influence financial outcomes for healthcare stakeholders across the U.S. healthcare system. The environment is quality-driven, highly regulated, and requires strong analytical precision and independent judgment. This is a role for professionals who thrive in detail-oriented clinical review work and are motivated by improving healthcare financial integrity at scale.
Accountabilities:
- Conduct comprehensive inpatient DRG validation and quality assurance reviews to assess coding accuracy based on ICD-10 guidelines, AHA Coding Clinic standards, and medical documentation.
- Analyze clinical records such as physician notes, lab results, imaging reports, and other supporting evidence to validate assigned DRGs and identify discrepancies.
- Manage assigned claims end-to-end while adhering to turnaround time requirements, client guidelines, and internal standard operating procedures.
- Participate in pre-payment, post-service, and post-pay audit processes to identify revenue integrity opportunities and ensure accurate reimbursement outcomes.
- Serve as a subject matter expert on DRG coding and validation, supporting internal teams with guidance and issue resolution.
- Contribute to quality assurance programs, training initiatives, and onboarding of new team members.
- Identify process gaps and recommend improvements to enhance efficiency, accuracy, and compliance within coding operations.
- Maintain strict adherence to privacy, regulatory, and organizational standards in all review activities.
Requirements:
- Registered Nurse qualification preferred with active clinical experience.
- Certification in inpatient coding required (e.g., CCS, CIC, RHIA, RHIT).
- 5+ years of experience in DRG review, ICD-10-CM coding, MS-DRG, or APR-DRG auditing in a healthcare or payer environment.
- Strong understanding of hospital billing structures, Medicare guidelines, and healthcare reimbursement systems.
- Solid clinical judgment with the ability to interpret complex medical documentation and apply coding rules accurately.
- Excellent analytical, critical thinking, and problem-solving skills.
- Strong attention to detail with high accuracy in documentation review and data interpretation.
- Effective communication skills with the ability to collaborate across teams and explain coding decisions clearly.
- Self-motivated professional with the ability to work independently in a structured, compliance-driven environment.
- Strong organizational skills and ability to manage multiple cases while meeting strict deadlines.
Benefits:
- Comprehensive healthcare coverage and wellness-focused programs.
- Family support benefits, including caregiving and reproductive health coverage.
- Paid holidays, PTO, and access to mental well-being resources.
- Learning and development support through educational and certification resources.
- Employee engagement initiatives, networking opportunities, and recognition programs.
- Financial wellness support and various employee discount programs.
- Inclusive workplace culture focused on diversity, equity, inclusion, and belonging.
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