USRN Nurses (Clinical Documentation, Coding)

Job Title: CDI / DRG Specialist (Pasig) | Onsite
Work Arrangement/Shift: Onsite (Work From Office), Night Shift
Start Date: ASAP (this June 2025)

Qualifications:

• Bachelors degree in Nursing or a related healthcare field.

• Must hold a valid Medical Coding License.

• 6 months to 1 year of experience working in a U.S. healthcare account.

• Solid understanding of anatomy, pathophysiology, disease processes, and treatment management.

• Proficient in medical coding standards, including ICD-10-CM & PCS, DRG classifications (MSDRG, APR-DRG), and related clinical coding compliance.

• Skilled in written English and effective in creating clinical queries.

• Willing to work onsite in Ortigas, Pasig City.

Responsibilities:

1. Clinical Documentation Review & Improvement:

• Review patient medical records, including progress notes, laboratory results, and physician documentation.
• Work closely with healthcare providers to ensure that clinical documentation is accurate, complete, and up-to-date.Identify gaps in documentation and query physicians to clarify diagnoses and procedures for accurate coding.
  
• Ensure that the documentation supports the correct DRG (Diagnosis-Related Group) assignment and that it aligns with U.S. coding standards and guidelines.

2. DRG Assignment & Compliance:

• Assign DRGs based on the clinical documentation provided and verify that DRG codes are correct for reimbursement purposes.
• Monitor DRG trends and ensure that any discrepancies or issues are flagged and resolved in a timely manner.
  
• Collaborate with coding teams to ensure that medical coding aligns with clinical documentation and DRG assignments.
• Maintain a thorough understanding of DRG-based reimbursement systems and U.S. healthcare regulations (CMS, ICD-10-CM/PCS, etc.).