Renee Krul, RN, BSN, CCDS, President and COO of DRG Claims Management
Renee brings over thirty-five years of nursing and healthcare cost containment experience in varied settings inclusive of hospitals, medical review companies, health plans, third party administrators and managed care organizations, most recently in Medicare Advantage and Dual Eligible plans. She developed and oversees all clinical services and business operations for DRG Claims Management, which provides DRG Auditing and Recovery services for any health plan that pays inpatient hospital claims based on DRG methodology. Renee’s strong background in compliance and managed care inspired her hallmark program development of risk-free auditing that delivers provider-signed agreements which effectively eliminates provider appeals for health plan clients. Previously, Renee was the President of Compliant DRG for three years, following ten years as a principal and Clinical Director of Total Claims Review & Management, Inc, providing both case management and bill review / auditing products.
Renee has also worked extensively as a consultant to health care plans in all aspects of cost management and has served as an expert witness in litigation related to payor-based case management and clinical documentation standards. Having obtained certifications as a Clinical Documentation Specialist and as a Case Manager, she is noted for her expertise in Reimbursement and DRG methodology, CMS reimbursement guidelines, clinical documentation standards, utilization management, case management of populations with chronic disabilities, discharge planning, provider contracting and relations, and denials/ appeals, Renee is a Registered Professional Nurse licensed in multiple states. She graduated from State University of New York School of Health Related Sciences in Syracuse, New York, State University of New York, Albany, New York with a Bachelor’s of Science in Nursing, and attended Rutgers University Graduation School of Nursing in Newark, New Jersey. Renee was the recipient of three national awards, the Nursing Spectrum’s Tri-State Region Nurse of the Year in 2005, Spina Bifida Association of America’s Healthcare Achievement Award in 2003, and the Case Management Society of America’s Case Manager of the Year in 1997.