Senior Claims Auditor - DRG

About the role

We are seeking a Senior 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.

Responsibilities

• Detect and correct coding errors to ensure accurate 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.

Requirements

• 6+ years experience of performing MS-DRG and ARP-DRG reviews for a Payment Integrity vendor or Payer required.
• An active certified coder credential (e.g., CIC, CPC, CCS, RHIA, or RHIT) required.
• CCS (Certified Coding Specialist) credential highly preferred.
• 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.
• RHIA, or RHIT credential, Associate's Degree in Health Information Management, Nursing, or related field preferred.
• Inpatient audits for case rate and per diem preferred.
• Experience working in a start-up or high-growth company environment, demonstrating agility and adaptability.
• Familiarity with working with a diverse, global team of talent.
• Excellent computer skills and familiarity with a Mac.

Benefits

• Medical, dental, vision, life, disability insurance, and Employee Assistance Program.
• 401K retirement plan with company match; flexible spending and health savings account.
• Flex Time Off + company holidays.
• Up to 14 weeks of paid parental leave.
• Pet insurance.

Pay & Perks

This fully remote opportunity offers a salary range of $85,000 to $100,000 annually; as part of a total benefits package which includes health insurance, 401k and bonus. In accordance with state applicable laws, Cohere is required to provide a reasonable estimate of the compensation range for this role. Individual pay decisions are ultimately based on a number of factors, including but not limited to qualifications for the role, experience level, skillset, and internal alignment.