Drg Validation Clinician

Summary

Join MedReview, a leader in payment integrity solutions, as a DRG Validation Clinician! This full-time, remote position offers flexibility to work from anywhere in the US. You will perform clinical record reviews, ensuring accurate medical coding and writing concise rationales. We seek an experienced clinician with utilization management, inpatient coding, or clinical validation experience. The role requires a minimum of two years of clinical review experience and three years of hospital-based clinical experience. Excellent benefits include comprehensive healthcare, 401k matching, generous PTO, wellness programs, and professional development opportunities.

Requirements

• Minimum of two years’ experience in some type of clinical review such as inpatient coding, utilization management, or clinical validation
• Knowledge of health insurance business, industry terminology, and regulatory guidelines
• Minimum of 3 years clinical experience in a hospital setting with experience including but not limited to reading histories and physicals, interpreting lab and test results, and discharge summaries
• Active, unrestricted RN license or graduation from Medical School
• Ability to use common computer applications, such as Word
• Understanding of anatomy, physiology, and diagnostic and surgical procedures
• Working knowledge of clinical criteria documentation requirements used to successfully substantiate code assignments
• The ability to accurately interpret a medical record
• The ability to work in an environment with productivity expectations
• High speed internet (100 Mbps per person recommended) with secured WIFI
• A dedicated workspace with minimal interruptions to protect PHI and HIPAA information
• Must be able to sit and use a computer keyboard for extended periods of time

Responsibilities

• Perform clinical record review, utilizing clinical expertise, judgement, guidelines, and policies to ensure the accuracy of medical coding
• Write clear, accurate and concise rationales in support of findings

Preferred Qualifications

CCS or CIC certification

Benefits

• Healthcare that fits your needs - We offer excellent medical, dental, and vision plan options that provide coverage to employees and dependents
• 401(k) with Employer Match - Join the team and we will invest in your future
• Generous Paid Time Off - Accrued PTO starting day one, plus additional days off when you’re not feeling well, and 11 observed holidays
• Wellness - We care about your well-being. From Commuter Benefits to FSAs we’ve got you covered
• Learning & Development - Through continued education/mentorship on the job and our investment in LinkedIn Learning, we’re focused on your growth as a working professional