Our client, a well-established healthcare organization, is seeking a Senior Clinical Coder to join a small, high-performing inpatient coding team as the subject matter expert on DRG validation and inpatient facility coding. This is a fully remote opportunity supporting claims review work tied to a federal healthcare program.
Company name is withheld at this stage, with details shared with qualified candidates during screening.
This role is best suited for someone with strong ICD-10-PCS and DRG methodology expertise who can handle complex coding questions and serve as a trusted team resource.
Location: Remote (U.S.)
Compensation: Up to $88K, or up to $90K in higher cost-of-living geographies
Target Start Date: August 3
Schedule: Must be available to work any shift
What You'll Do
- Serve as the SME on inpatient coding and DRG validation for a small, focused coding team
- Conduct retrospective claims review for coding and pricing determinations on inpatient facility claims, including diagnosis and procedural coding and DRG assignment
- Lead coding projects and mentor other Clinical Coders
- Perform focused outpatient and inpatient claims reviews and summarize findings for leadership
- Identify potential fraudulent or quality issues and escalate appropriately
- Research payer manuals and current coding guidelines to support authorization decision support processes
- Prepare determination notices and written correspondence
- Review coding issues flagged by external quality monitoring and document findings, rationale, and corrective actions
Required Qualifications
- High School Diploma or GED
- Current certification as CIC, CCS, RHIT, RHIA, or CPC
- Hands-on DRG assignment and/or DRG validation experience
- U.S. Citizen
- Must be able to receive a favorable interim and adjudicated final federal background investigation
- Minimum 5 years of clinical coding experience in facility and/or professional accounts
- Minimum 3 years of claims processing experience in inpatient and/or outpatient accounts
- Documented experience working in a fast-paced environment
Preferred Qualifications
- Experience in private medical industry, health insurance, or managed care
- Familiarity with federal/military healthcare programs
- Medical insurance
- Vision insurance
- Dental insurance
Location
N/A
Employment Type
Contractor
Experience Level
Senior
Salary Range
Up to $90,000
Remote work allowed
Yes
Posted
1 month ago