DRG Reviewer-5

The Inpatient DRG Reviewer at Zelis conducts comprehensive quality assurance reviews on inpatient discharge group claims to identify coding errors and optimize revenue for clients. Using industry standard guidelines like ICD-10 and AHA Coding Clinic, the role involves analyzing medical records to determine accurate diagnosis and procedure codes, then regrouping claims to justify revised DRG assignments. This position requires writing detailed rationale statements for coding changes and managing claims turnover while adhering to strict privacy standards.