DRG Reviewer

Location: Remote - Missouri, United States

Salary: $70,100–$126,200 per year

Company

hirify.global is a national healthcare organization serving 28 million members through community-focused health plans and services.

What you will do

• Conduct independent MS-DRG and APR-DRG coding and clinical validation reviews.
• Verify ICD-10-CM/PCS assignments, clinical diagnoses, inpatient reimbursement rules, and payment accuracy.
• Identify coding errors, upcoding, documentation discrepancies, and regulatory or contractual compliance issues.
• Collaborate with the Medical Director on complex cases and provide expert recommendations.
• Prepare audit findings supported by AHA Coding Clinic, ICD-10 guidelines, company policies, and clinical guidelines.
• Support audit strategy by developing audit concepts, identifying opportunities, and selecting claims for review.

Requirements

• Associate degree in Health Information Management, Nursing, or a related field.
• At least 4 years of experience performing MS-DRG and APR-DRG coding.
• At least 2 years of experience performing DRG reviews for a payment integrity vendor or payer.
• At least 2 years of experience using a DRG encoder or grouper such as TruCode/TruBridge, 3M, Optum Encoder, Webstrat, or PSI.
• Required credential: RHIT, RHIA, CCS, CICP, or CCDS.
• Inpatient hospital documentation improvement experience is preferred; RN licensure with a coding credential is also preferred.

Culture & Benefits

• Remote work with a flexible approach to remote, hybrid, field, or office schedules.
• Health insurance, 401(k), stock purchase plans, tuition reimbursement, paid time off, and holidays.
• Compensation is adjusted based on skills, experience, education, and other job-related factors.
• Equal opportunity workplace committed to diversity and fair consideration of qualified applicants.