- Responsible for reviewing medical records to determine the accuracy of coding and reimbursement for clinical services rendered to beneficiaries of health plans
- Reviews inpatient medical records to validate, assignment and sequencing of ICD-9-CM and ICD-10 diagnosis and procedure codes, discharge status codes, and DRG assignment.
- Provides a detailed rationale for every medical record review resulting in a DRG Review Results letter, including supporting references.
- Utilizes proper reference material, standards, and guidelines for coding.