Who We Are:

At the intersection of health plans and providers, Apixio is creating a leading Connected Care platform to minimize reimbursement inaccuracies and high-quality patient care so they can thrive as the industry moves toward value-based reimbursement models. 

The combination brings together healthcare expertise, AI/machine learning technology and data-driven analytics solutions to deliver innovative solutions and value to our customers and the healthcare ecosystem. We aim to accelerate the shift toward alternative payment models, while enhancing efficiency and supporting better patient outcomes.

The DRG Reviewer is responsible for performing DRG payment validation (clinical/coding) reviews of medical records
and/or other documentation as defined by contract specific review criteria. This involves accurately documenting
findings and providing clinical/policy/regulatory support for payment determination.

Essential Duties and Responsibilities:

Responsible for auditing patient medical records using clinical and coding guideline knowledge along with
payer requirements to ensure reimbursement accuracy. Provide clear, concise, and compelling rationale and supporting clinical evidence to provider or payer for
recommendations or reconsiderations of unsupported billed codes. Collaborate with team leaders to ensure DRG denial is thoroughly reviewed. Perform all audits in observance of organizational quality and timeliness standards set by the audit
operations management team. Utilizes proprietary auditing systems and intellectual property with a high level of proficiency to make sound
and consistent audit determinations and generate audit letters. Makes recommendations for improvements to the audit system that enhance efficiency. Assures HIPAA compliance for protected health information. Other duties as assigned.

 

Job Requirements:

Education (required)
 Associate or bachelor’s degree in nursing (active/unrestricted license); or
 Associate or bachelor’s degree in health information management; or
 Work experience may be considered in lieu of formal education at leadership discretion
Certification (at least one of the following is required)
 RHIA - Registered Health Information Administrator; or
 RHIT- Registered Health Information Technician; or
 CCDS – Certified Clinical Documentation Specialist; or
 CDIP – Clinical Documentation Improvement Practitioner; or
 CCS - Certified Coding Specialist; or
 CPC-H, Certified Professional Coder-H (Hospital Based); or
 CIC, Certified Inpatient Coder
Experience
 Inpatient claims auditing, quality assurance or recovery auditing experience of 2 years or more required
 Inpatient Clinical Documentation Integrity experience of 2 years or more required

 Exhibits high standards for quality and attention to detail
 Displays deep patterns of curiosity and mastery to understand the root cause of events and behaviors
 Demonstrated ability to apply critical review judgment to make clinical and/or coding determinations
 Solid knowledge and understanding of clinical criteria and documentation requirements to successfully
substantiate code assignments
 Subject matter expert in DRG methodologies (e.g., MS & APR)
 Subject matter expert in ICD-10-CM/PCS coding methodologies, UHDDS definitions, Official Coding
Guidelines and AHA’s Coding Clinic Guidelines
 Demonstrates ability to work efficiently and effectively with minimal direct supervision

 

The salary range below is for Base Salary.  Total compensation also includes benefits and variable compensation.  Compensation will be determined based on several factors including, but not limited to, skill set, years of experience, and the employee’s geographic location.Base Compensation$48,000—$90,000 USD

We recognize that people come with experience and talent beyond just the technical requirements of a job. If your experience is close to what you see listed here, please consider applying. Diversity of experience and skills combined with passion is a key to innovation and excellence. Therefore, we encourage people from all backgrounds to apply to our positions. Your skills and background may be more translatable to this role than you initially thought.  Allow us the opportunity to get to know you.  Please let us know if you require accommodations during the interview process.

What Apixio can offer you:

Meaningful work to advance healthcare  Competitive compensation Exceptional benefits, including medical, dental and vision, FSA 401k with company matching up to 4% Generous vacation policy Remote-first & hybrid work philosophies A hybrid work schedule (2 days in office & 3 days work from home) (Note: If the position is designated as REMOTE it will stay REMOTE) Modern open office in beautiful San Mateo, CA; Los Angeles, CA; San Diego, CA; Austin, TX and Dallas, TX Subsidized gym membership Catered, free lunches Parties, picnics, and wine-downs Free parking

We take your privacy very seriously. Please review our privacy policy to see exactly how we protect your information here

We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace.

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