Remote DRG Reviewer

Summary

Join Apixio, a leading Connected Care platform, as a DRG Reviewer to perform DRG payment validation reviews of medical records and provide clinical/policy/regulatory support for payment determination. The ideal candidate will have experience in inpatient claims auditing, quality assurance or recovery auditing, and be proficient in proprietary auditing systems and intellectual property.

Requirements

• Associate or bachelor’s degree in nursing (active/unrestricted license); or Associate or bachelor’s degree in health information management; or Work experience may be considered in lieu of formal education at leadership discretion
• RHIA - Registered Health Information Administrator; or RHIT- Registered Health Information Technician; or CCDS – Certified Clinical Documentation Specialist; or CDIP – Clinical Documentation Improvement Practitioner; or CCS - Certified Coding Specialist; or CPC-H, Certified Professional Coder-H (Hospital Based); or CIC, Certified Inpatient Coder
• Inpatient claims auditing, quality assurance or recovery auditing experience of 2 years or more required Inpatient Clinical Documentation Integrity experience of 2 years or more required

Responsibilities

• Responsible for auditing patient medical records using clinical and coding guideline knowledge along with payer requirements to ensure reimbursement accuracy
• Provide clear, concise, and compelling rationale and supporting clinical evidence to provider or payer for recommendations or reconsiderations of unsupported billed codes
• Collaborate with team leaders to ensure DRG denial is thoroughly reviewed
• Perform all audits in observance of organizational quality and timeliness standards set by the audit operations management team
• Utilizes proprietary auditing systems and intellectual property with a high level of proficiency to make sound and consistent audit determinations and generate audit letters
• Makes recommendations for improvements to the audit system that enhance efficiency
• Assures HIPAA compliance for protected health information

Benefits

• Competitive compensation
• Exceptional benefits, including medical, dental and vision, FSA
• 401k with company matching up to 4%
• Generous vacation policy
• Remote-first & hybrid work philosophies
• A hybrid work schedule (2 days in office & 3 days work from home)