DRG Integrity Analyst

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

📋 Description

• Conduct initial evaluations of inpatient charts to pinpoint opportunities and risks for DRG optimization.

• Perform high-level clinical and coding evaluations with an emphasis on principal diagnosis, procedures, CC/MCCs, and sequencing.

• Identify gaps in documentation, unsupported diagnoses, and coding discrepancies that affect DRG assignments.

• Triage and escalate confirmed opportunities to Clinical Coding Analysts (CCAs) for an in-depth review.

• Implement standardized screening workflows and DRG methodologies to ensure accuracy, consistency, and productivity.

• Thoroughly document screening decisions and justifications to support downstream workflows and ensure audit defensibility.

• Maintain productivity and quality benchmarks in a high-volume review setting.

• Collaborate with CCAs and leadership to enhance best practices and workflow efficiencies.

• Recognize trends, risks, and process deficiencies to bolster continuous improvement initiatives.

⛳️ Requirements

• Required credentials include CCS, RHIT, RHIA, CDIP, or CCDS.

• A minimum of 2 years of inpatient coding experience is essential.

• Familiarity with MS-DRG methodology, focusing on principal diagnosis, CC/MCCs, and procedure-driven DRGs is necessary.

• Capability to conduct high-level clinical and coding assessments (screening/triage level, not full coding).

• Proficient in applying ICD-10-CM/PCS coding guidelines at a screening level.

• Excellent attention to detail and an ability to adhere to structured, repeatable workflows.

• Strong skills in documentation and communication are required.

• Ability to operate independently in a remote, high-volume environment while fulfilling productivity standards.

• Strong organizational, time management, and prioritization abilities are essential.

🏝️ Benefits

• Comprehensive medical, dental, and vision insurance.

• 401(k) plan with company matching.

• Generous paid time off alongside eight paid holidays.

• Fully remote work environment with company-provided equipment.

• Opportunities for professional development, leadership training, and internal advancement.

• Recognition programs and performance-based incentives.

• Employee wellness resources and discount programs.

• White glove onboarding designed to ensure your success.

• A collaborative, people-first culture acknowledged as a Great Place to Work® for three consecutive years.