Remote opportunity at
MedReviewDRG Reviewer
MedReview, a provider of payment integrity solutions operating for over forty years, is looking for a remote DRG Reviewer to join the Payment Integrity team. This…
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About This Role
MedReview, a provider of payment integrity solutions operating for over forty years, is looking for a remote DRG Reviewer to join the Payment Integrity team. This full-time position focuses on analyzing inpatient medical records and claims to confirm coding accuracy, ensure appropriate DRG assignments, and identify reimbursement savings opportunities for regional and national health plans. This role suits professionals with a strong background in acute inpatient coding and healthcare reimbursement…
Job Description
MedReview, a provider of payment integrity solutions operating for over forty years, is looking for a remote DRG Reviewer to join the Payment Integrity team. This full-time position focuses on analyzing inpatient medical records and claims to confirm coding accuracy, ensure appropriate DRG assignments, and identify reimbursement savings opportunities for regional and national health plans.
This role suits professionals with a strong background in acute inpatient coding and healthcare reimbursement who excel in independent, fast-paced home office environments. Successful candidates will apply advanced critical thinking and regulatory expertise to evaluate claims while meeting established quality and productivity standards. The position requires availability during Eastern Standard Time business hours and adherence to strict confidentiality guidelines.
Daily duties involve evaluating medical records against current coding guidelines, partnering with Physician Reviewers on complex clinical cases, and documenting findings accurately. The role also includes participating in quality improvement initiatives, team meetings, and continuous professional development.
Responsibilities
- Examine inpatient medical records and claims to verify ICD-10-CM/PCS coding correctness and appropriate DRG allocation
- Utilize Official Coding Guidelines, AHA Coding Clinic instructions, and CMS rules during evaluations
- Spot documentation gaps, coding errors, and potential reimbursement savings
- Partner with Physician Reviewers on cases needing additional clinical assessment
- Produce clear and detailed documentation of review findings and rationales
- Fulfill established quality and productivity targets within required timeframes
- Comply with all data security, HIPAA, and confidentiality standards
Requirements
- Hold a current CCS, CIC, or RHIT coding certification
- Possess at least three years of professional experience in acute inpatient coding, DRG validation, coding audits, or payment integrity reviews
- Demonstrate strong knowledge of ICD-10-CM/PCS coding rules and DRG systems
- Show proficiency in Microsoft Office tools such as Outlook, Word, and Excel
- Maintain a secure, distraction-free home workspace with high-speed internet
- Be available to work during Eastern Standard Time business hours
Qualifications
- Background in payment integrity, DRG auditing, or healthcare claims review
- Experience validating both MS-DRG and APR-DRG models
- Familiarity with payer reimbursement policies and claims operations
- Bachelor degree in Health Information Management, Healthcare Administration, Nursing, or a related discipline
- Prior experience working remotely within a healthcare review setting
Core Skills
Benefits
- Comprehensive medical, dental, and vision insurance
- 401(k) plan featuring an employer match
- Generous paid time off and paid holidays
- Flexible spending accounts and commuter benefits
- Support for professional development and continuing education
- Access to LinkedIn Learning and ongoing training programs
- Employee wellness initiatives
Frequently Asked Questions
Answers are based only on the employer’s listing; where it doesn’t say, neither do we.
Is this position fully remote?
Yes, this is a fully remote position, though candidates are required to be available during Eastern Standard Time business hours.
What is the salary range for the DRG Reviewer role?
The annual salary range is $85,000 to $95,000, determined by the candidate's level of experience.
What certifications are required for this job?
Applicants must hold at least one active coding certification, specifically a Certified Coding Specialist, Certified Inpatient Coder, or Registered Health Information Technician.
Sample Interview Questions
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