Cohere Health is a Software-as-a-Service (SaaS) company focused on improving the patient journey by enhancing the quality of care at lower costs, as well as emp
Senior DRG Auditor
Location
United States
Posted
1 day ago
Salary
$85K - $100K / year
Seniority
Senior
No structured requirement data.
Job Description
Senior DRG Auditor
Cohere Health
Role Description We are seeking a Senior DRG Auditor, Disputes 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. - 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. Qualifications - 6+ years experience of performing MS-DRG and ARP-DRG reviews for a Payment Integrity vendor or Payer required. - Experience with provider appeals/dispute reviews 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. - An active certified coder credential (e.g., CIC, CPC, CCS, RHIA, or RHIT) required. - CCS (Certified Coding Specialist) credential highly preferred. - 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. - 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 preferred. - Inpatient audits for case rate and per diem. - 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. - Payment Integrity audit experience preferred. Benefits - Fully remote opportunity with about 5% travel - 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 Interview Process - Connect with Talent Acquisition for a Preliminary Phone Screening - Meet your Hiring Manager! - Case Study - Interview with Subject Matter Expert - Behavioral Interview(s)
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