Certified DRG Analyst

Job Summary

A company is looking for a DRG Analyst to conduct clinical audits and ensure the accuracy of DRG claims.

Key Responsibilities

• Conduct clinical audits and verify the accuracy of DRG claims through medical record reviews
• Identify billing discrepancies and compliance risks while providing education on post-audit findings
• Collaborate with internal teams and external resources to resolve claim issues and enhance departmental goals

Required Qualifications

• 3-5 years of experience in auditing, claims review, or billing within a healthcare organization
• In-depth knowledge of ICD-10-CM/PCS, HCPCS/CPT, APR-DRG, MS-DRG codes, and DRG grouping systems
• Experience with bill and concurrent review, as well as DRG validation
• Active certification as a coder (RHIA, RHIT, CPC, CIC, COC, or CCS) is required
• Familiarity with Microsoft Office applications and healthcare insurance guidelines