Senior DRG & IBR Content Ideation Lead (Remote)

3M HEALTHCARE; Morristown (NJ); Hybrid; USD 105,000 - 133,000; Full time

Benefits offered by this job

401k with employer match

Health benefits (medical, dental, &amp

Paid time off

Job summary

Zelis is modernizing the healthcare financial experience. The Senior Content Ideation Specialist will develop and deliver content for Itemized Bill Review and DRG Validation within the Expert Claim Review suite, sourcing from ICD-10, AHA, AMA, CPT, CMS and clinical research sources.

The role collaborates with Operations and Product to ensure scalable, compliant content and supports DRG Coding and Clinical Validation (MS/APR) efforts across multiple projects; in-office and hybrid/remote options

Qualifications

• Bachelor’s degree with 4+ years of clinical and/or medical coding experience.
• Current, active CIC or CCS or equivalent credentialing is required.
• RN or LPN with coding certification, or RHIA/RHIT with 6–8 years of experience.
• Experience with MS-DRG/APR-DRG coding and compliance required.
• Experience performing regulatory research from multiple sources and presenting findings.

Responsibilities

• Serve as subject matter expert for day-to-day activities and data accuracy.
• Review DRG and IBR disputes and explain rationale within required timeframes.
• Provide content support for inquiries, training, governance and research requests.
• Create education for Operations, CMO and other departments on new concepts.
• Research and analyze content for Itemized Bill Review and DRG Validation.
• Maintain ECR content including DRG rationales and policies.
• Perform regulatory research to track compliance enhancements.
• Analyze data to assess content impact and coordinate product alerts.

Skills

Clinical coding

MS-DRG/APR-DRG coding

Regulatory research

Payer reimbursement policies

Microsoft Office Suite

JIRA/Confluence

Project management

Communication skills

Education

Bachelor’s degree

CIC/CCS or equivalent credential

RN/LPN with coding certification OR RHIA/RHIT

Tools

JIRA/Confluence

MS Office

Job description

Zelis is modernizing the healthcare financial experience. The Senior Content Ideation Specialist will develop and deliver content for Itemized Bill Review and DRG Validation within the Expert Claim Review suite, sourcing from ICD-10, AHA, AMA, CPT, CMS and clinical research sources.

The role collaborates with Operations and Product to ensure scalable, compliant content and supports DRG Coding and Clinical Validation (MS/APR) efforts across multiple projects; in-office and hybrid/remote options