• Review medical records and clinical documentation to ensure accurate, complete, and compliant coding in accordance with CMS regulations, federal and state guidelines (e.g., AHIMA, CMS, Medicaid), and payer-specific policies. • Conduct routine and focused coding audits to identify documentation gaps, coding discrepancies, and areas of compliance risk. • Collaborate with clinical leadership, revenue cycle, and compliance teams to resolve coding discrepancies and support accurate documentation practices. • Communicate audit findings to providers and coding staff, providing actionable, audit-defensible recommendations and targeted education. • Perform follow-up audits to validate remediation efforts and ensure sustained improvements in coding accuracy and compliance. • Prepare written reports of findings to Compliance Leadership on charts reviewed per quarter, coding accuracy metrics, and identified risk areas. • Serve as a subject matter expert on pediatric, Medicaid, telehealth, and behavioral health coding, providing guidance on complex or high-risk scenarios. • Interpret and apply state-specific Medicaid and payer billing requirements, maintain expertise across multiple markets and ensure alignment with regulatory and contractual guidelines; continuously research, monitor, and educate providers and coding staff on emerging payer policies, state expansions, and industry changes.

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)

Role Description In this position... - Our Global Dealer Engagement team builds successful partnerships with our 9,500 dealers. - Helps dealers unlock their full potential and increase customer satisfaction. - Focuses on training and productivity, governance, customer sentiment, diversity, community, retail excellence, systems and process modernization, and rewards and recognition. - Aims to help dealers differentiate themselves from the competition and maximize their strengths. Qualifications - Marketing, sales, and service expertise. - Ability to turn data-driven insights into innovative solutions. - Experience enhancing sales and customer loyalty. Requirements - Strong partnership-building skills. - Experience in training and productivity improvement. - Knowledge of governance and customer sentiment analysis. Benefits - Opportunity to work with a visionary vehicle and mobility services company. - Chance to make a significant impact on customer experience.

• Design and execute risk-based audit and sampling programs across classification, reference data, and governed datasets. • Test outputs against authored rules, definitions, and quality thresholds, documenting pass/fail evidence. • Quantify quality across dimensions (accuracy, completeness, consistency, timeliness) and track trends over time. • Validate the effectiveness of human-in-the-loop review, identifying where validation is or is not catching errors. • Investigate root causes of quality issues and recommend rule, process, or training improvements. • Produce clear audit findings, scorecards, and assurance reporting for governance and leadership. • Maintain audit trails and evidence sufficient to support internal and external scrutiny. • Partner with Governance to refine rules and thresholds based on observed failure patterns.