Inpatient DRG Sr Reviewer

Role Overview: Zelis India is on a mission to enhance the healthcare financial experience and you will play a crucial role in this by supporting various initiatives. You will be responsible for performing comprehensive inpatient DRG validation Quality Assurance reviews to ensure accuracy of the DRG billed, managing claims, serving as a Subject Matter Expert on DRG validation, and identifying new DRG coding concepts to expand the DRG product. Your role will involve implementing and conducting quality assurance programs, preparing and conducting training for new team members, and recommending efficiencies and process improvements. Key Responsibilities: - Perform comprehensive inpatient DRG validation Quality Assurance reviews based on coding guidelines and clinical evidence - Implement and conduct quality assurance program to ensure accurate results - Manage assigned claims and claim report, adhering to client turnaround time and department Standard Operating Procedures - Serve as the Subject Matter Expert on DRG validation - Prepare and conduct training for new team members - Identify new DRG coding concepts to expand the DRG product - Meet and/or exceed all internal and department productivity and quality standards - Remain current in all national coding guidelines - Recommend efficiencies and process improvements - Maintain awareness of and ensure adherence to Zelis standards regarding privacy - Must be available to travel 25% - 50% as required Qualifications Required: - Registered Nurse licensure preferred - Inpatient Coding Certification required (i.e., CCS, CIC, RHIA, RHIT) - 5+ years reviewing and/or auditing ICD-10 CM, MS-DRG and APR-DRG claims preferred - Solid understanding of audit techniques, revenue opportunities, and financial negotiation - Experience and working knowledge of Health Insurance, Medicare guidelines, and various healthcare programs - Strong understanding of hospital coding and billing rules - Clinical and critical thinking skills for appropriate coding - Excellent communication skills both verbal and written - Strong organization skills with attention to detail - Demonstrated thought leadership and motivation skills Company Details: Zelis India fosters a holistic workplace experience with hybrid work flexibility, comprehensive healthcare benefits, financial wellness programs, and cultural celebrations. The company culture emphasizes professional growth through a collaborative work environment, leadership development, and global exposure. Zelis India also maintains high standards of service delivery and has been recognized with awards for its culture. Note: Benefits/Perks section omitted as it is not specifically related to the job role.,