Opportunity Overview:
We are seeking an Inpatient Auditor to join our dynamic Payment Integrity team. This critical role involves conducting comprehensive MS-DRG and APR-DRG coding reviews to ensure the accuracy of claims and maximize overpayment identification. If you possess a CCS credential, superior knowledge of ICD-10-CM/PCS coding guidelines, and a passion for deep analytical work, you will be instrumental in supporting Cohere Health’s commitment to accurate reimbursement solutions. This opportunity requires a self-motivated individual who thrives on precision, compliance, and continuous learning in a high-growth environment.
What you’ll do:
- Conduct comprehensive MS-DRG and APR-DRG coding reviews to ensure accuracy in DRG assignment and reimbursement.
- Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications.
- Craft clear, concise, and well-supported audit findings, backed by AHA Coding Clinic Guidelines and ICD-10-CM/PCS regulations.
- Utilize advanced DRG encoder tools to drive efficiency and accuracy in audits.
- Meet or exceed company quality and productivity standards, including strong uphold rates for appeals.
- Stay ahead of industry trends, coding updates, and compliance regulations to maintain expert-level knowledge.
- Adhere to HIPAA and company policies and procedures to ensure data security and regulatory compliance.
- Maintain and apply superior knowledge of changes and updates to coding guidelines, reimbursement trends, and health payment policy language.
What you’ll need:
- 3+ years experience of performing MS-DRG and ARP-DRG reviews for a Payment Integrity vendor or Payer required.
- Requires advanced expertise in ICD-10-CM/PCS coding and the ability to exercise discretion and professional judgment in assessing complex clinical information, validating diagnosis code assignments, and identifying discrepancies such as coding errors or upcoding.
- Prepares clear, concise, and well-supported audit findings, referencing authoritative sources such as AHA Coding Clinic and ICD-10 guidelines, ensuring recommendations reflect professional expertise.
- Self-motivated and able to work independently in a remote environment while maintaining high performance.
- Consistently meets or exceeds established quality and productivity standards while managing priorities and workflow autonomously.
- Passion for DRG auditing and a commitment to teamwork, collaboration, and continuous learning.
- Possess the CCS (Certified Coding Specialist) credential.
- Excellent written and verbal communication skills, strong analytical skills, and attention to detail.
- RHIA, or RHIT credential, Associate's Degree in Health Information Management, Nursing, or related field.
- Inpatient audits for case rate and per diem.
- Experience working in a star