Specialist,DRG Case Management

Medical Pre-authorization Team is looking for a dedicated DRG Inpatient Pre-authorization Specialist to join us in strengthening our approvals and drive case management.

Job Purpose

• The jobholder will be responsible for managing inpatient cases as per defined TAT and ensuring accuracy of DRG codes submitted by Healthcare Providers.
• Jobholder must possess ability to deliver in a metric driven high pressure environment which functions in real time.
• Strong attention to detail; high degree of speed and adjudication accuracy.
• Strong proficiency in handling computer and software skills.

Job Responsibilities

• Visit providers to manage inpatient cases, review DRG codes/severity levels submitted by healthcare facilities.
• Coordinate with physicians/providers efficiently and Ensure effective communication with provider.
• Negotiate cost with providers, ensure correct length of stay of inpa...