DRG Reviewer
5 days ago
About the Role
AdeptMed Healthcare Solutions LLP is seeking an experienced DRG Reviewer / Clinical Documentation Specialist (CDS) with NCLEX-RN (USA) or Registered Nurse (RN) credentials to join our US Healthcare Quality & Audit team.
You will be responsible for reviewing clinical documentation, validating DRG assignments, and ensuring compliance with CMS, ICD-10-CM, and PDPM standards for hospital and SNF settings.
Key Responsibilities
- Perform clinical documentation reviews and validate assigned Diagnosis Related Groups (DRGs) for accuracy and compliance.
- Review inpatient and outpatient records to ensure correct coding and medical necessity.
- Collaborate with coding, MDS, and clinical teams to resolve documentation discrepancies.
- Ensure alignment with CMS, AHA Coding Clinic, and UHDDS guidelines.
- Identify documentation deficiencies and provide feedback for improvement.
- Support Clinical Documentation Improvement (CDI) initiatives to enhance coding accuracy and case mix index (CMI).
- Prepare audit summaries, reports, and recommendations to optimize quality and revenue integrity.
- Maintain up-to-date knowledge of ICD-10-CM, MS-DRG, and PDPM rules.
- Ensure adherence to HIPAA and patient confidentiality standards.
Qualifications & Experience
Education:
- Registered Nurse (RN) – NCLEX-RN Licensed (USA) is mandatory.
- Bachelor's or Master's Degree in Nursing (B.Sc. / M.Sc. Nursing) from a recognized institution.
Experience:
- 3–8 years of experience in Clinical Documentation Review, DRG Validation, or Medical Record Auditing.
- Prior experience in US Healthcare, CDI, or Quality Review strongly preferred.
Certifications (Preferred):
- NCLEX-RN (USA) – Mandatory
- CCDS / CDIP / CCS / CPC – Preferred
- Familiarity with ICD-10-CM, MS-DRG, PDPM, and CMS guidelines
Key Skills
DRG Validation · Clinical Documentation Improvement (CDI) · NCLEX-RN (USA) ·
ICD-10 Coding · PDPM · CMS Guidelines · Medical Record Audit ·
Case Mix Index (CMI) · Quality Review · Nursing Audit · US Healthcare Process
Perks & Benefits
- Competitive salary based on US Healthcare experience.
- 5-day working week (Saturday & Sunday off).
- Health insurance and flexible schedule.
- Growth opportunities in the US Healthcare Audit & CDI domain.
- Supportive and collaborative work environment.
To Apply:
Send your resume to
Job Types: Full-time, Permanent
Pay: ₹386, ₹647,161.58 per year
Benefits:
- Flexible schedule
- Health insurance
- Leave encashment
- Paid sick time
Work Location: In person
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