Remote DRG Auditor & Coding Reviewer

Rawlings Company; United States; Remote; USD 90,000 - 115,000; Full time

Benefits offered by this job

Top Medical/Dental/Vision offerings

FSA/HSA

Tuition reimbursement

Competitive salary, 401(k) with match

PTO

Flexible benefits and perks

Job summary

Machinify is seeking a DRG Reviewer to join its Complex Payment Solutions Team. You will conduct thorough DRG payment validation reviews, including clinical and coding assessments of medical records, to ensure accurate payment determinations and compliant documentation.

The role requires deep knowledge of ICD-10-CM/PCS, DRG methodologies, and regulatory guidelines, with responsibilities to document findings, provide evidence-based rationale, and collaborate with stakeholders.

Qualifications

• Deep knowledge of clinical criteria and documentation requirements.
• Experience with DRG methodologies and ICD-10-CM/PCS coding.
• Familiarity with InterQual/MCG criteria is a plus.
• Ability to audit inpatient claims and ensure compliance.

Responsibilities

• Audit patient medical records using clinical, coding, and payer guidelines.
• Provide clear, evidence-based rationale for code recommendations.
• Collaborate with team leaders to review DRG denials.
• Ensure audits align with quality and timeliness standards.

Skills

Audit coding knowledge

Attention to detail

Independent work

Analytical skills

Education

Health info degree

Job description

Machinify is seeking a DRG Reviewer to join its Complex Payment Solutions Team. You will conduct thorough DRG payment validation reviews, including clinical and coding assessments of medical records, to ensure accurate payment determinations and compliant documentation.

The role requires deep knowledge of ICD-10-CM/PCS, DRG methodologies, and regulatory guidelines, with responsibilities to document findings, provide evidence-based rationale, and collaborate with stakeholders.