Revu Healthcare

The auditor reviews inpatient claims and medical records to ensure DRG accuracy based on ICD-10 guidelines and clinical documentation. They are responsible for writing detailed rationales for audit determinations and identifying new audit concepts to improve payment integrity.

The nurse will review denied medical claims and write objective narrative appeal letters to request reconsideration based on clinical facts and medical literature. They are responsible for applying prudent clinical judgment and updating logs for follow-up and payer reporting.

Perform inpatient coding reviews and validation audits to ensure DRG assignment accuracy and compliance. Identify coding discrepancies and provide clear rationales while adhering to client-specific audit tools and workflows.

Perform outpatient coding reviews and validation audits to ensure accuracy and regulatory compliance. Identify coding discrepancies and provide clear rationales while following client-specific audit tools and workflows.