DRG Coder

This is a fully remote position, open to applicants in California.

📋 Description

• Review inpatient hospital records and accurately assign diagnosis and procedure codes.

• Ascertain the correct MS-DRG or APR-DRG assignment based on coding and clinical documentation.

• Perform coding validation and auditing to ensure adherence to payer and regulatory standards.

• Identify documentation deficiencies and communicate improvement opportunities to providers, hospitals, and Clinical Documentation Improvement (CDI) teams.

• Analyze denials and underpayments associated with coding and DRG assignments.

• Support retrospective and concurrent reviews of high-cost admissions and outlier cases.

• Collaborate with utilization management, case management, finance, and contracting teams to enhance reimbursement and control costs.

• Assist with both internal and external audits, including RAC, Medicare Advantage, Medicaid, and commercial payer reviews.

• Provide training and mentorship to coding staff and other stakeholders.

• Stay updated on changes in coding guidelines, reimbursement methodologies, and regulatory requirements.

• Prepare reports and summaries concerning coding accuracy, financial implications, and audit results.

• Uphold confidentiality and comply with HIPAA and company policies.

• Other responsibilities as assigned.

⛳️ Requirements

• Associate’s degree in Health Information Management, Nursing, or a related field.

• At least 5 years of inpatient coding experience.

• Minimum of 2 years' experience in advanced DRG validation, auditing, or hospital reimbursement.

• One or more of the following certifications are required: CCS, RHIA, or RHIT from the American Health Information Management Association; CIC or CPC from AAPC.

• Possess advanced knowledge of ICD-10-CM, ICD-10-PCS, MS-DRG, and APR-DRG methodologies.

• Proficiency in coding software, electronic medical records, and Microsoft Office applications.

• Ideal candidates will have:

• Experience with Medicare Advantage, Medicaid, and commercial health plans.

• Background in a delegated IPA, MSO, or managed care setting.

• Strong understanding of Medicare reimbursement and payer audit processes.

• Ability to interpret intricate clinical documentation.

• Familiarity with utilization management, case management, and managed care operations.

• Exceptional analytical, organizational, and problem-solving abilities.

• Capability to work independently and manage multiple priorities effectively.

• Excellent written and verbal communication skills.

🏝️ Benefits

• This position is remote within the U.S., with the home office located at 600 City Parkway West, 10th Floor, Orange, CA 92868.

• Occasional in-person meetings with internal departments and external providers/hospitals for training or audit purposes are required.

• The national target pay range for this role is between $33.00 - $38.00, with actual compensation determined by geographic location (current or future), experience, and other job-related factors.