Inpatient Medical Coder / DRG Reviewer (CCS or CIC Certificate)

Kavi Software Technologies Philippines Corp.; Iloilo City; In loco; PHP 300.000 - 550.000; Tempo pieno

Descrizione del lavoro

KAVI Philippines is seeking a DRG Reviewer to validate inpatient coding and optimize reimbursements. The role focuses on post-billed claims, ICD-10 coding accuracy, and DRG assignments within a dedicated DRG database.

Ideal candidates have 3+ years in inpatient coding and hold CCS or CIC certification, with strong attention to detail and knowledge of DRG methodologies. This is an onsite, full-time role based in Iloilo City.

Competenze

• Active CCS or CIC certification.
• Bachelor’s or Associate’s degree in Health Information Management or related field.
• Minimum 3 years’ inpatient coding, DRG validation, or coding review.
• Strong knowledge of ICD-10-CM/PCS and DRG reimbursement.
• Experience with post-bill review and DRG software.
• Ability to handle PHI securely.

Mansioni

• Review inpatient claims imported into the DRG database, focusing on diagnosis, procedures, grouping logic, and reimbursement accuracy.
• Analyze weekly hospital billing files, identifying underpaid claims based on ICD-10 diagnosis and procedure codes.
• Conduct detailed medical record reviews post-bill to determine if submitted diagnosis and procedure codes are accurate and complete.
• Identify and correct errors such as under coded or misclassified diagnoses and procedures.
• Identify new revenue opportunities related to all inpatient DRG related components.
• Stay informed on coding updates, payer guidelines, and DRG changes to support accurate recommendations.

Conoscenze

ICD-10-CM/PCS knowledge

Attention to detail

PHI handling and confidentiality

Post-bill review experience

Data analysis

Communication with clients

Formazione

Bachelor's or Associate's degree in Health Information Management

RHIT or RHIA certification (nice to have)

Strumenti

DRG software

Post-bill systems

EMRs / EHR platforms

Descrizione del lavoro

DRG Reviewer (Inpatient Coding & Revenue Integrity)
KAVI Philippines
Location: Iloilo City (Onsite)
Work Setup: Full-time, Night Shift

Role Overview

KAVI Philippines is seeking a DRG Reviewer responsible for reviewing post-billed inpatient claims to identify and validate missed reimbursement opportunities. The role involves analyzing medical records and billing data to ensure accurate ICD-10 coding and DRG assignment, with the goal of optimizing hospital reimbursement outcomes.

DRG Reviewers will work within a specialized DRG database and apply clinical coding expertise to evaluate documentation accuracy, identify coding gaps, and recommend reimbursement adjustments.

Key Responsibilities

• Review inpatient claims imported into the DRG database, focusing on diagnosis, procedures, grouping logic,and reimbursement accuracy.

• Analyze weekly hospital billing files, identifying underpaid claims based on ICD-10 diagnosis and procedure codes.

• Conduct detailed medical record reviews post-bill to determine if submitted diagnosis and procedure codes are accurate and complete.

• Navigate medical records efficiently, targeting specific sections (e.g., discharge summary, operative reports) based on system edits and flagged items.

• Match clinical documentation in the medical record to corresponding ICD-10 codes, ensuring DRG accuracy.

• Identify and correct errors such as under coded or misclassified diagnoses and procedures.

• Utilize Health ROI system edits to detect specific high-value opportunities (e.g., dialysis, occlusion, embolization, catheterization).

• Make reimbursement improvement recommendations and submit findings for client review and approval.

• Collaborate with leadership on case prioritization and workflow management.

• Stay informed on coding updates, payer guidelines, and DRG changes to support accurate recommendations.

• Identify new revenue opportunities related to all inpatient DRG related components.

• Other duties as required.

Qualifications (Must Have)

• Active CCS (Certified Coding Specialist) or CIC (Certified Inpatient Coder) certification

• Bachelor’s or Associate’s degree in Health Information Management or related field

• Minimum 3 years’ experience in inpatient coding, DRG validation, or coding review

• Strong knowledge of ICD-10-CM/PCS coding and DRG reimbursement methodology

• Experience with post-bill review and coding/billing systems or DRG software

• High attention to detail and ability to manage large datasets

• Strong understanding of medical documentation and hospital billing processes

• Ability to handle confidential patient information (PHI) with strict professionalism

Nice to Have

• RHIT or RHIA certification

• Experience in revenue integrity or reimbursement optimization analysis

• Familiarity with EMRs and multiple healthcare platforms

• Experience working with external clients or cross-functional teams

• Knowledge of financial impact analysis for underpaid claims