DRG Reviewer

Job Title: DRG Reviewer

Department: Coding

Reports to: Director of DRG Review Operations/Coding

Summary: Provide support as needed to the Director of DRG Review Operations/Coding.

Duties and Responsibilities:

  • Validate ICD-9-CM coding to ensure proper DRG assignment in order to screen out over billed cases

  • Validate/assign CPT codes to assure proper billing

  • Refer cases with possible utilization and/or quality issues

  • Bring to the attention of the managers and other key staff involved in the review process of any other issues and problems that case review may present

  • Perform on-site reviews within and outside of New York State as assigned

  • Perform varied types of reviews in central office when assigned

  • Adhere to and maintain qualitative and quantitative standards

  • Coordinate and collaborate on scheduled on-site reviews with other reviewers and the host department in order to ensure the timely completion of the review

  • Record review decisions and justifications for changes requested or issues raised

  • Report daily and weekly output

  • Inform the personnel involved in the review process of any applicable coding guidelines, conventions and information that will ensure quality in DRG reviews

  • Maintain professional credentialed status by participating in approved continuing education programs and seminars

  • Perform other duties related to the review process as deemed necessary by the director

Minimum Qualifications: Applicants must have education, training and/or experience demonstrating competence in each of the following areas.

  • Ability to prioritize and organize workload and complete tasks independently

  • Ability to communicate effectively both orally and in writing

  • Knowledge of various computer software

  • Individual must have a minimum of two years ICD-9-CM/CPT coding experience. RHI, RHIT and CCS a plus

We offer a competitive salary and an excellent fringe benefit package.

Should you have interest in any of the above positions, please email or fax your resume to:

Human Resources Department

Fax to: 212-897-6050

E-mail to: hr@medreview.us (you may click on this link to send)

(Please attach resume in MS Word or WordPerfect format)

For information on how to apply for this position, click here.