Senior DRG Auditor (Disputes)

TL;DR

Senior DRG Auditor (Disputes): Conducting comprehensive MS-DRG and APR-DRG coding reviews to ensure claim accuracy and maximize overpayment identification with an accent on provider appeals and dispute resolution. Focus on applying expert ICD-10-CM/PCS knowledge to validate clinical information and maintain compliance in a high-growth healthcare environment.

Location: Must be based in the United States (Remote with ~5% travel)

Salary: $85,000–$100,000 annually

Company

hirify.global is a clinical intelligence platform using AI-powered solutions to streamline payer-provider collaboration and healthcare economics.

What you will do

• Perform comprehensive MS-DRG and APR-DRG coding reviews to ensure reimbursement accuracy.
• Manage provider appeals and dispute reviews using expert clinical judgment.
• Draft clear, evidence-based audit findings referencing AHA Coding Clinic and ICD-10 guidelines.
• Utilize advanced encoder tools to drive efficiency and maintain high quality standards.
• Stay current on health payment policy, coding updates, and regulatory compliance.
• Collaborate with a diverse team to ensure data security and adherence to HIPAA policies.

Requirements

• 6+ years of experience performing MS-DRG and APR-DRG reviews for a Payer or Payment Integrity vendor.
• Active certified coder credential (e.g., CIC, CPC, CCS, RHIA, or RHIT) required.
• Advanced expertise in ICD-10-CM/PCS coding and provider appeals.
• Must be based in the United States.
• Ability to work independently in a remote environment while meeting productivity standards.
• Experience in a high-growth or startup environment.

Nice to have

• CCS (Certified Coding Specialist) credential.
• Associate's Degree in Health Information Management or Nursing.
• Prior experience in Payment Integrity auditing.

Culture & Benefits

• Comprehensive medical, dental, vision, life, and disability insurance.
• 401(k) retirement plan with company match.
• Flexible Time Off and company holidays.
• Up to 14 weeks of paid parental leave.
• Pet insurance and Employee Assistance Program.

Hiring process

• Preliminary phone screening with Talent Acquisition.
• Interview with Hiring Manager and Subject Matter Expert.
• Case study and behavioral interviews.