Team Lead, DRG Auditing

3 hours, 44 minutes ago
Full-time
Lead
Software Development
Cohere Health

Cohere Health

Cohere Health transforms healthcare utilization management and prior authorization, aligning physicians and health plans for better patient outcomes and reduced costs.

Insurance
251-1K
Founded 2019
$56M raised

Description

  • Lead and mentor a team of auditors, including workload management and professional development support.
  • Collaborate cross-functionally to align on production targets, quality review, and timelines.
  • Conduct comprehensive coding and DRG audits to validate claim accuracy and reimbursement.
  • Prepare clear, well-supported audit findings using authoritative coding and regulatory sources.
  • Use advanced DRG encoder tools to improve audit efficiency and accuracy.
  • Apply expert knowledge of coding guidelines to identify overpayments, coding errors, and upcoding.
  • Monitor and maintain quality and productivity standards, including appeal uphold rates.
  • Stay current on coding updates, reimbursement trends, and compliance regulations.
  • Ensure adherence to HIPAA and company policies and procedures.
  • Work independently in a remote environment while managing priorities and workflow.

Requirements

  • 8+ years of experience performing MS-DRG and ARP-DRG reviews for a Payment Integrity vendor or payer.
  • 2-3 years of supervisory or management experience, including remote supervision and training.
  • CCS (Certified Coding Specialist) credential highly preferred.
  • RHIA or RHIT credential, or an Associate's degree in Health Information Management, Nursing, or a related field preferred.
  • Preference for candidates with both a coding credential and an HIM credential (RHIA/RHIT).
  • Advanced expertise in ICD-10-CM/PCS coding and complex clinical review.
  • Experience using AHA Coding Clinic Guidelines, ICD-10 guidelines, CMS NCDs/LCDs, and clinical criteria guidelines.
  • Ability to exercise discretion and professional judgment in validating diagnosis code assignments and identifying discrepancies.
  • Excellent written and verbal communication skills, strong analytical skills, and attention to detail.
  • Experience with inpatient audits for case rate and per diem; outpatient and professional claims auditing experience preferred.
  • Experience in a start-up or high-growth environment is preferred.
  • Familiarity with working with a diverse, global team is preferred.
  • Excellent computer skills and familiarity with a Mac.

Benefits

  • Fully remote role with about 5% travel.
  • Medical, dental, vision, life, and disability insurance.
  • Employee Assistance Program (EAP).
  • 401(k) retirement plan with company match.
  • Flexible spending account and health savings account.
  • Time off plus company holidays.
  • Up to 14 weeks of paid parental leave.
  • Pet insurance.
  • Annual salary range of $100,000 to $110,000, plus bonus.

Interested in this position?

Apply directly on the company website

Apply Now

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