Claims Auditor (Medtech)

TL;DR

Claims Auditor (Medtech): Conducting MS-DRG and APR-DRG coding reviews to ensure claims accuracy and maximize overpayment identification with an accent on ICD-10-CM/PCS coding guidelines. Focus on validating complex clinical information, identifying upcoding errors, and maintaining high uphold rates for appeals.

Location: Must be based in the United States (excluding AK, CA, CO, HI, NY, and WA)

Salary: $72,000 – $82,000 annually

Company

AI-powered clinical intelligence platform streamlining access to quality care and improving payer-provider collaboration through a Payment Integrity Suite.

What you will do

• Perform comprehensive MS-DRG and APR-DRG coding reviews to ensure accuracy in DRG assignment and reimbursement.
• Identify overpayments using expert knowledge of coding guidelines and advanced DRG encoder tools.
• Draft clear, concise audit findings backed by AHA Coding Clinic Guidelines and ICD-10-CM/PCS regulations.
• Maintain compliance with HIPAA and company data security policies.
• Stay current with industry trends, coding updates, and health payment policy language.

Requirements

• 3+ years of experience performing MS-DRG and APR-DRG reviews for a Payer or Payment Integrity vendor.
• CCS (Certified Coding Specialist) credential required.
• Advanced expertise in ICD-10-CM/PCS coding and assessing complex clinical information.
• Ability to work independently in a remote environment while maintaining high productivity.
• Excellent written and verbal communication skills with high attention to detail.

Nice to have

• RHIA or RHIT credential.
• Associate's Degree in Health Information Management, Nursing, or a related field.
• Experience working in a startup or high-growth company environment.
• Familiarity with Mac computers.

Culture & Benefits

• Fully remote work arrangement with approximately 5% travel.
• Comprehensive medical, dental, vision, life, and disability insurance.
• 401K retirement plan with company match, HSA, and flexible spending accounts.
• Flex Time Off and company paid holidays.
• Up to 14 weeks of paid parental leave and pet insurance.

Hiring process

• Preliminary phone screening with Talent Acquisition.
• Interview with the Hiring Manager.
• Case Study evaluation.
• Technical interview with a Subject Matter Expert.
• Final behavioral interview.