DRG Clinical Dispute Reviewer
Zelis(1 month ago)
About this role
The DRG Clinical Dispute Reviewer at Zelis is responsible for resolving facility and provider disputes related to DRG validation by reviewing claims for adherence to proper coding and billing. This role involves analyzing DRG claims, managing disputes with the Office of the Chief Medical Officer, and ensuring quality and production metrics are met.
Required Skills
- DRG Validation
- Claims Review
- Coding Guidelines
- Dispute Management
- Quality Assurance
Qualifications
- Inpatient Coding Certification
- Bachelor’s Degree Preferred
- Registered Nurse Licensure Preferred
About Zelis
zelis.comDiscover the connected platform that's bridging gaps and aligning interests of healthcare payers, providers, and healthcare consumers.
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