DRG Reviewer / Clinical Documentation Specialist (NCLEX-RN Licensed – USA Healthcare)

About the Role

AdeptMed Healthcare Solutions LLP is seeking an experienced DRG Reviewer / Clinical Documentation Specialist (CDS) with NCLEX-RN (USA) or Registered Nurse (RN) credentials to join our US Healthcare Quality & Audit team.
You will be responsible for reviewing clinical documentation, validating DRG assignments, and ensuring compliance with CMS, ICD-10-CM, and PDPM standards for hospital and SNF settings.

Key Responsibilities

• Perform clinical documentation reviews and validate assigned Diagnosis Related Groups (DRGs) for accuracy and compliance.
• Review inpatient and outpatient records to ensure correct coding and medical necessity.
• Collaborate with coding, MDS, and clinical teams to resolve documentation discrepancies.
• Ensure alignment with CMS, AHA Coding Clinic, and UHDDS guidelines.
• Identify documentation deficiencies and provide feedback for improvement.
• Support Clinical Documentation Improvement (CDI) initiatives to enhance coding accuracy and case mix index (CMI).
• Prepare audit summaries, reports, and recommendations to optimize quality and revenue integrity.
• Maintain up-to-date knowledge of ICD-10-CM, MS-DRG, and PDPM rules.
• Ensure adherence to HIPAA and patient confidentiality standards.

Qualifications & Experience

Education:

• Registered Nurse (RN) – NCLEX-RN Licensed (USA) is mandatory.
• Bachelor’s or Master’s Degree in Nursing (B.Sc. / M.Sc. Nursing) from a recognized institution.

Experience:

• 3–8 years of experience in Clinical Documentation Review, DRG Validation, or Medical Record Auditing.
• Prior experience in US Healthcare, CDI, or Quality Review strongly preferred.

Certifications (Preferred):

• NCLEX-RN (USA) – Mandatory
• CCDS / CDIP / CCS / CPC – Preferred
• Familiarity with ICD-10-CM, MS-DRG, PDPM, and CMS guidelines

Key Skills

DRG Validation · Clinical Documentation Improvement (CDI) · NCLEX-RN (USA) ·
ICD-10 Coding · PDPM · CMS Guidelines · Medical Record Audit ·Case Mix Index (CMI) · Quality Review · Nursing Audit · US Healthcare Process

Perks & Benefits

• Competitive salary based on US Healthcare experience.
• 5-day working week (Saturday & Sunday off).
• Health insurance and flexible schedule.
• Growth opportunities in the US Healthcare Audit & CDI domain.
• Supportive and collaborative work environment.

To Apply:
Send your resume to info@adeptmed.in

Job Types: Full-time, Permanent

Pay: ₹386,618.73 - ₹647,161.58 per year

Benefits:

• Flexible schedule
• Health insurance
• Leave encashment
• Paid sick time

Work Location: In person