Senior DRG Auditor (Disputes)

Opportunity Overview: We are seeking a Senior DRG Auditor, Disputes 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: 6 + years experience of performing MS-DRG and ARP-DRG reviews for a Payment Integrity vendor or Payer required. Experience with provider appeals/dispute reviews 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. An active certified coder credential (e.g., CIC, CPC, CCS, RHIA, or RHIT) required. CCS (Certified Coding Specialist) credential highly preferred. Self-motivated and able to work independently in a remote environment while maintaining high performance. Consistently meets or exceeds