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DRG Reviewer at Zelis - ApplyBlast

DRG Reviewer

Zelis

1 day ago

3.4 on Glassdoor

Hyderabad, Telangana, India

Hybrid

Full Time

Medior

0 applicants

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About this role

The Inpatient DRG Reviewer conducts comprehensive post-service, pre-payment, and post-payment reviews of inpatient DRG claims to ensure accuracy based on industry coding guidelines and clinical evidence. The role involves validating billed DRGs, determining appropriate diagnosis and procedure codes, and regrouping claims to identify savings opportunities for clients. This position requires strong expertise in DRG coding, clinical evaluation, and adherence to healthcare financial standards.

Responsibilities

Conduct comprehensive inpatient DRG validation reviews based on clinical evidence and coding guidelines
Determine and record appropriate diagnosis, procedure, and discharge status codes from medical records
Regroup claims using software to determine new DRGs and write rationale statements for discrepancies

Skills

Qualifications

CCSCICRHIARHIT

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.