Claims Auditor

Opportunity Overview

We are seeking an 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. 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.

What you'll do

• 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.

What you'll need

• 3+ years experience of performing MS-DRG and ARP-DRG reviews for a Payment Integrity vendor or Payer 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.
• 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.
• Possess the CCS (Certified Coding Specialist) credential.
• 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.
• 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.

Pay & Perks

• 💻 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

The salary range for this position is $72,000 to $82,000 annually. This role is not eligible for hire in: AK, CA, CO, HI, NY, or WA.

Interview Process

1. Connect with Talent Acquisition for a Preliminary Phone Screening
2. Meet your Hiring Manager!
3. Case Study
4. Interview with Subject Matter Expert
5. Behavioral Interview

About Cohere Health

Cohere Health's clinical intelligence platform delivers AI-powered solutions that streamline access to quality care by improving payer-provider collaboration, cost containment, and healthcare economics.

Equal Opportunity Statement

Cohere Health is an Equal Opportunity Employer. We are committed to fostering an environment of mutual respect where equal employment opportunities are available to all.

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