We are
seeking a Senior Inpatient DRG Coding Analyst – Payment Integrity with deep
expertise in acute inpatient coding, clinical validation, and US healthcare
claims auditing. In this role, you will work on complex inpatient cases for US
health plans, ensuring coding accuracy, clinical integrity, and payment
correctness. You will play a key role in identifying payment variances,
strengthening audit defensibility, and supporting compliance initiatives. This
is an excellent opportunity to move into payer-side payment integrity, working
with advanced tools, data, and audit methodologies.

Key
Responsibilities

• Conduct end-to-end
  audits of acute inpatient claims covering coding accuracy, clinical
  validation, and DRG assignment
  
• Validate principal and
  secondary diagnoses, CC/MCC capture, procedures (ICD-10-PCS), Present on
  Admission (POA) indicators, and final MS-DRG / APR-DRG assignment
  
• Review medical records
  and provider documentation for completeness and accuracy
  
• Apply expertise in
  ICD-10-CM/PCS, MS-DRG / APR-DRG methodologies, CMS guidelines, and Coding
  Clinic updates
  
• Utilize encoders, DRG
  groupers, and claims platforms to validate payment outcomes
  
• Apply clinical judgment
  and medical necessity criteria to support audit findings
  
• Prepare clear,
  defensible audit documentation for internal review and appeals
  
• Ensure compliance with
  CMS, HIPAA, and payer guidelines
  
• Meet defined
  productivity and quality benchmarks
  

Requirements