Team Lead, DRG Auditing (Healthcare)

TL;DR

Team Lead, DRG Auditing (Healthcare): Leading a team of auditors to ensure claims accuracy and maximize overpayment identification within a high-growth payment integrity environment. Focus on managing remote team performance, applying expert knowledge of ICD-10-CM/PCS coding guidelines, and driving efficiency through advanced DRG encoder tools.

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

Salary: $100,000–$110,000 annually.

Company

hirify.global is a clinical intelligence platform using AI-powered solutions to streamline healthcare access, improve payer-provider collaboration, and enhance cost containment.

What you will do

• Lead, mentor, and manage a remote team of auditors, overseeing workloads and professional development.
• Conduct comprehensive coding reviews to ensure accuracy and maximize overpayment identification.
• Collaborate cross-functionally to meet production, quality, and timeline standards.
• Craft clear, well-supported audit findings based on AHA Coding Clinic and ICD-10-CM/PCS regulations.
• Utilize advanced DRG encoder tools to drive efficiency and maintain high uphold rates for appeals.
• Ensure strict adherence to HIPAA and company data security policies.

Requirements

• Must be based in the United States.
• 8+ years of experience performing MS-DRG and ARP-DRG reviews for a Payment Integrity vendor or Payer.
• 2-3 years of supervisory or management experience, specifically in a remote environment.
• Advanced expertise in ICD-10-CM/PCS coding and CMS NCDs/LCDs.
• Ability to work independently in a remote setting while maintaining high performance.
• Strong analytical skills and excellent written/verbal communication.

Nice to have

• CCS (Certified Coding Specialist) credential.
• RHIA or RHIT credential.
• Experience with outpatient and professional claims auditing.
• Experience in a start-up or high-growth company environment.

Culture & Benefits

• Comprehensive medical, dental, vision, life, and disability insurance.
• 401K retirement plan with company match.
• Flexible spending and health savings accounts.
• Up to 14 weeks of paid parental leave.
• Generous time off and company holidays.
• Pet insurance and Employee Assistance Program.

Hiring process

• Preliminary phone screening with Talent Acquisition.
• Interview with the Hiring Manager.
• Technical interview with a Subject Matter Expert.
• Behavioral interview.