Job Description:

Job Description: IP Approval Officer with DRG Experience

Responsibilities:

• Review and approve/deny inpatient claims based on medical necessity and DRG guidelines
• Analyze medical records, treatment plans, and other relevant documents to determine appropriateness of care
• Communicate with healthcare providers to gather additional information as needed
• Ensure compliance with regulatory requirements and company policies
• Maintain accurate and detailed documentation of all review decisions

Skill Sets:

• Strong knowledge of DRG classification system and medical coding
• Experience working in a healthcare setting, preferably in utilization management or a similar role
• Excellent analytical and critical thinking skills
• Ability to work independently and make sound decisions under pressure
• Strong communication and interpersonal skills
• Attention to detail and ability to maintain confidentiality

Qualifications:

• Bachelor’s degree in healthcare administration, nursing, or a related field
• Certification in medical coding or utilization management (e.g. CRC, CUC, CCDS) preferred
• Minimum of 2 years of experience in IP approval or utilization review
• Familiarity with insurance policies and procedures
• Proficiency in Microsoft Office and other relevant software

Industry:

HealthCare

Category:

Health

Skills: