Review acute inpatient medical records and claims to validate coding accuracy, DRG assignment, and payment integrity. The role focuses on ensuring physician documentation supports coded hospital data and that coding complies with official guidelines, CMS requirements, and industry standards.
The position is posted across three levels (I, II, III), with increasing responsibility for complex audits, mentoring, training, escalation support, and leadership backup duties.
Requirements & Qualifications
Minimum qualifications
- Associate or bachelor’s degree in Health Information Management (RHIA or RHIT) or a nursing degree
- Current coding certification maintained as a condition of employment: RHIA, RHIT, CCS, or CIC
- 3+ years of experience in claims auditing, quality assurance, or recovery auditing for MS/APR-DRG coding in an acute facility setting
- 3+ years of experience with ICD-10-CM, MS-DRG, and APR-DRG
- Broad knowledge of medical claims billing/payment systems, provider billing guidelines, medical necessity criteria, and coding terminology
- Intermediate analytical and problem-solving skills
- Intermediate knowledge of PC, software, auditing tools, and claims processing systems
Higher-level qualifications
- Level II: 5+ years of relevant experience and advanced analytical/problem-solving ability
- Level III: 8+ years of relevant experience, demonstrated leadership, subject matter expertise, and strong project management and presentation skills
Benefits & Perks
Benefits and perks
- Medical insurance
- Dental insurance
- Retirement plan
- Wellness program
- Paid time away from work
- Paid holidays
Location
New York, US
Employment Type
Full-time
Experience Level
Intermediate Level
Salary Range
$65,346 - $142,322
Remote work allowed
Yes
Posted
2 months ago