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DRG Reviewer-7 at Zelis - ApplyBlast

DRG Reviewer-7

Zelis

3 months ago

3.4 on Glassdoor

Hyderabad, India

Hybrid

Full Time

Senior

0 applicants

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About this role

The Inpatient DRG Reviewer at Zelis conducts comprehensive post-service, pre-payment, and post-pay reviews of inpatient DRG claims to optimize savings for clients. This role involves validating billed diagnoses and procedure codes against medical records, ICD-10 guidelines, and clinical criteria to determine accurate discharge status and DRG assignments. Reviewers document audit findings, justify code revisions, and identify new coding concepts to expand the DRG product while adhering to strict productivity and quality standards.

Responsibilities

Conduct comprehensive inpatient DRG validation reviews based on industry coding guidelines
Determine and record appropriate diagnosis, procedure, and discharge status codes
Regroup claims using software to identify new DRG assignments and justify revisions
Document audit findings including clinical rationale and provider communications
Identify new DRG coding concepts to expand product offerings and improve efficiency

Skills

Qualifications

Inpatient Coding Certification (CCS, CIC, RHIA, or RHIT)Registered Nurse licensure (preferred)

About Zelis

zelis.com

Headquarters

Boston, Massachusetts, United States

Company Size

1001-5000 employees

Founded

2016

View Profile

Zelis is a healthcare financial technology company that provides a connected platform for payers, providers, and healthcare consumers. Their solutions span network optimization, claims management, price transparency, payments, and member engagement communications. Zelis serves more than 770 payers and thousands of providers nationwide, helping reduce costs and administrative burden across the healthcare financial system.