California Licensed DRG Dispute Reviewer

Job Summary

A company is looking for a DRG Dispute Reviewer.

Key Responsibilities

• Evaluate provider-submitted appeals and original audit findings to validate or revise DRG determinations
• Review inpatient medical records and documentation to ensure correct DRG assignment and adherence to coding guidelines
• Prepare evidence-based rationales to support determinations for clients, providers, or payers

Required Qualifications

• An associate or bachelor's degree in nursing or health information management is required
• At least one relevant certification such as RHIA, RHIT, CCS, CIC, or CDIP/CCDS is required
• A minimum of 3 years of inpatient hospital coding experience is required
• A minimum of 4 years of DRG validation experience is required
• Experience in DRG dispute reviews and clinical validation is strongly preferred