State Licensed 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 for correct DRG assignment and adherence to coding guidelines Prepare clear, 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, or equivalent work experience At least one relevant certification: RHIA, RHIT, CCS, CIC, CDIP, or CCDS Minimum 3 years of inpatient hospital coding experience Minimum 4 years of DRG validation experience, with a preference for dispute review and recovery audits Expert-level knowledge of ICD-10-CM/PCS coding systems and MS-DRG/APR-DRG methodologies