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DRG Reviewer

Zelis

Hyderabad, Telangana, India Full-time June 02, 2026
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Opportunity Description

Position Overview

The InpatientDRGReviewer will be primarily responsible for conducting post-service, pre-payment and post pay comprehensive inpatientDRGreviews based on industry standardinpatient codingguidelines and rules, evidence based clinical criteria plan, and policy exclusions. Conduct reviews on inpatientDRGclaims as they compare with medical records ICD-10 OfficialCodingGuidelines, AHACodingClinic and client specific coverage policies. Conduct prompt claim review to support internal inventory management to achieve greatest savings for clients. Please share relevant profiles at the earliest. Let us know if you need any further details.

We are looking for professionals with strong expertise inDRG. The ideal candidates should have:

KeyResponsibilities:

  • Perform comprehensive inpatientDRGvalidation reviews to determineaccuracyof theDRGbilled, based on industry standardcodingguidelines and the clinical evidence supplied by the provider in the for...
  • Full-time Other Healthcare Practitioners and Technical Occupations

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