Inpatient DRG Reviewer

The Inpatient DRG Reviewer is responsible for conducting comprehensive post-service, pre-payment, and post-payment reviews of inpatient DRG claims to ensure accuracy and compliance with industry coding guidelines and clinical criteria. The role involves analyzing medical records to validate and revise diagnosis and procedure codes, regrouping claims to determine the correct DRG, and documenting findings to support client savings and operational efficiency. This position requires strong expertise in DRG validation, clinical evaluation, and adherence to strict productivity and quality standards.