Supervisor, Payment Integrity- Coding & Clinical (DRG)

Location: Remote-MO

Salary: $87,700–$157,800 per year

Company

hirify.global is a diversified national healthcare organization serving 28 million members.

What you will do

• Supervise daily Coding & Clinical Review workflows, including DRG audits, quality assurance, readmissions, appeals, and related operations.
• Monitor productivity, quality, service levels, and review accuracy; address performance gaps.
• Provide guidance on coding, clinical validation, audit determinations, ICD-10-CM/PCS guidelines, DRG methodologies, and payer policies.
• Resolve complex or escalated cases and support appeals through documentation review and determination validation.
• Conduct audits, calibration sessions, and inter-rater reliability reviews to improve consistency.
• Analyze operational and audit data, collaborate with Medical Directors, Provider Relations, Compliance, and Appeals, and support process improvement.

Requirements

• Associate's degree in Health Information Management, Nursing, or a related field.
• 6+ years of MS-DRG and APR-DRG coding experience.
• 3+ years of DRG review experience for a Payment Integrity vendor or payer.
• 3+ years of experience with DRG encoders or groupers such as TruCode/TruBridge, 3M, Optum Encoder, Webstrat, or PSI.
• RHIT, CCS, or CIC certification required; CCDS or RN licensure with a coding credential is also accepted or preferred as specified.
• 1+ year of inpatient documentation improvement, complex appeal/dispute review, or auditor education and training experience preferred.

Culture & Benefits

• Remote role with a flexible approach to remote, hybrid, field, or office work schedules.
• Health insurance, 401(k), and stock purchase plans.
• Tuition reimbursement, paid time off, and holidays.
• Equal opportunity workplace committed to diversity and inclusion.