Responsible for independently conducting comprehensive reviews of MS-DRG and APR-DRG coding and clinical documentation to ensure accurate DRG assignment and reimbursement. The role requires advanced expertise in ICD-10-CM/PCS coding, strong clinical judgment, and the ability to identify coding errors, upcoding, and other discrepancies while supporting DRG validation reviews and appeals.
- Independently perform MS-DRG and APR-DRG coding and clinical validation reviews.
- Verify ICD-10-CM/PCS assignments and validate clinical diagnoses.
- Collaborate with the Medical Director on complex cases.
- Identify opportunities to develop medical policy when guidelines are not established.
- Prepare well-supported audit findings using authoritative coding and clinical sources.
- Evaluate claims and medical records for compliance with regulations, payer contracts, and company policies.
- Contribute to audit concepts, review selection, and strategic initiatives.
- Maintain quality and productivity standards while managing workload autonomously.
Requirements & Qualifications
Education and experience
- Associate's degree in Health Information Management, Nursing, or a related field required.
- 4+ years of experience performing MS-DRG and APR-DRG coding required.
- 2+ years of experience performing DRG reviews for a Payment Integrity vendor or payer required.
- 2+ years of experience using a DRG encoder/grouper such as TruCode/TruBridge, 3M, Optum Encoder, Webstrat, PSI, or similar required.
- 1+ years of inpatient hospital documentation improvement experience preferred.
Licenses and certifications
- RHIT, RHIA, CCS, CICP, or CCDS required.
- RN licensure or higher may be preferred when combined with a coding credential.
Additional qualifications
- Advanced knowledge of ICD-10-CM/PCS coding and DRG methodologies.
- Ability to exercise independent judgment and professional discretion.
- Strong analytical, documentation, and compliance skills.
Benefits & Perks
Benefits and perks
- Competitive pay
- Health insurance
- 401(k) and stock purchase plans
- Tuition reimbursement
- Paid time off and holidays
- Flexible remote, hybrid, field, or office work schedules
Location
Missouri, US
Employment Type
Full-time
Experience Level
Senior
Salary Range
$70,100 - $126,200
Remote work allowed
Yes
Posted
2 weeks ago