DRG (Coding) Reviewer/Auditor

TL;DR

DRG (Coding) Reviewer/Auditor (Healthcare): Analyze and review inpatient claims for coding accuracy and proper DRG assignment using ICD-10-CM/PCS codes with an accent on clinical validation and regulatory compliance. Focus on performing comprehensive reviews, collaborating with physicians, and ensuring 95% accuracy in billing validation.

Location: Remote (US-based with US-specific benefits like 401(k) and FSAs)

Salary: $85,000–90,000 annually

Company

Leading authority in payment integrity solutions including DRG Validation, Cost Outlier, and Readmission reviews.

What you will do

• Analyze inpatient claims following Official Coding Guidelines to validate ICD-10-CM/PCS codes and DRG assignments.
• Perform comprehensive initial reviews per standard operating procedures.
• Collaborate with physician reviewers as needed.
• Prioritize workload, complete tasks independently, and attend team meetings/training.
• Report daily productivity and meet/exceed expectations while maintaining 95% accuracy.

Requirements

• Coding Certification required (CCS, CIC, or RHIT) and must be maintained.
• College-level courses in medical terminology, anatomy, pathophysiology, pharmacology, and medical coding.
• At least 3 years’ experience in MS-DRG/APR-DRG validation in acute care inpatient coding/auditing.
• Adherence to Official Coding Guidelines, AHA Coding Clinic, CMS regulations.
• Proficiency in Outlook, Word, Excel; excellent communication skills.
• High-speed secured internet (100 Mbps), dedicated workspace for PHI/HIPAA protection.

Culture & Benefits

• Healthcare: medical, dental, vision for employees/dependents.
• 401(k) with employer match.
• Generous PTO accrued from day one, plus sick days and holidays.
• Wellness: Commuter Benefits, FSAs.
• Learning & Development: on-the-job mentorship, LinkedIn Learning.