DRG Reviewer (Healthcare Payment Integrity)

Location: Fully remote; availability during Eastern Standard Time (EST) business hours required

Salary: $85,000–$95,000 annually, commensurate with experience

Company

hirify.global provides payment integrity solutions that help health plans and healthcare organizations improve payment accuracy, reduce administrative waste, and optimize healthcare outcomes.

What you will do

• Review inpatient medical records and claims to validate ICD-10-CM/PCS coding and MS-DRG or APR-DRG assignment.
• Apply Official Coding Guidelines, AHA Coding Clinic guidance, CMS regulations, and reimbursement policies.
• Identify coding discrepancies, documentation concerns, payment integrity findings, and reimbursement savings opportunities.
• Collaborate with Physician Reviewers and interdisciplinary teams on complex clinical documentation and claim determinations.
• Document review findings, rationales, recommendations, and productivity results accurately.
• Meet required quality, accuracy, productivity, and turnaround-time benchmarks while supporting continuous improvement.

Requirements

• Current CCS, CIC, or RHIT certification.
• At least 3 years of experience in acute inpatient coding, DRG validation, coding audits, or payment integrity review.
• Strong knowledge of ICD-10-CM/PCS coding guidelines, DRG methodologies, CMS regulations, and reimbursement policies.
• Proficiency with Microsoft Office applications, including Outlook, Word, and Excel.
• Strong analytical, organizational, critical thinking, written, and verbal communication skills.
• Ability to work independently in a remote environment during EST business hours.

Nice to have

• Experience in payment integrity, DRG auditing, or healthcare claims review.
• Experience with both MS-DRG and APR-DRG validation.
• Knowledge of payer reimbursement methodologies and claims operations.
• Bachelor's degree in Health Information Management, Healthcare Administration, Nursing, or a related field.
• Previous experience in a remote healthcare review environment.

Culture & Benefits

• Medical, dental, and vision coverage.
• 401(k) with employer match, paid time off, paid holidays, FSA, and commuter benefits.
• Professional development, continuing education support, LinkedIn Learning, and ongoing training.
• Employee wellness programs and a collaborative, mission-driven work environment.
• Secure workspace, high-speed internet, and distraction-free remote work setup required for confidential HIPAA-regulated information.