⏰ Full time

DRG Reviewer-2

🏢

Zelis

                    Location
                    📍 Hyderabad, India
                

                    Posted
                    📅 June 20, 2026
                

                    Work Type
                    ⏰ Full time
                

Position Overview

Position Overview
 :The Inpatient DRG Reviewer will be primarily responsible for conducting post-service, pre-payment and post pay comprehensive inpatient DRG reviews based on industry standard inpatient coding guidelines and rules, evidence based clinical criteria plan, and policy exclusions. Conduct reviews on inpatient DRG claims as they compare with medical records ICD-10 Official Coding Guidelines, AHA Coding Clinic and client specific coverage policies. Conduct prompt claim review to support internal inventory management to achieve greatest savings for clients.
Key Responsibilities:
Perform comprehensive inpatient DRG validation reviews to determine accuracy of the DRG billed, based on industry standard coding guidelines and the clinical evidence supplied by the provider in the form of medical records such as physician notes, lab tests, images (x-rays etc.), and with due consideration to any applicable medical policies, medical best practice, etc.
            

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Job Details

⏰

Employment Type

Full time

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