State Licensed DRG Dispute Reviewer
virtual vocationsDenver (CO)
State Licensed DRG Dispute Reviewer
Posted today
virtual vocationsDenver (CO)
SENIORITY
Senior
About the role
Evaluating provider appeals and original audit findings, the remote State Licensed DRG Dispute Reviewer will determine correct DRG assignments and payment outcomes, ensuring compliance and accuracy in documentation and reimbursement practices.
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
Before you apply
Applying takes about a minute. These four things decide how fast it moves after that.
Your profile is current
It's what we read first. Occupations, seniority and locations matter more than a long history.
Two examples you can talk through
Not a portfolio — just two pieces of work where you can explain the decisions and what you'd change.
A number in mind
What you're on now and what would make you move. We negotiate better when we know both.
Your notice period
Employers plan around it, and it's the question that stalls offers most often.
Once you apply, someone reads it and calls you before anything reaches the employer — usually within two working days.