CCS Certified Inpatient Coder

Job Summary

To support accurate claims processing, the remote DRG Inpatient Coding Validator will ensure compliance with quality assurance standards, identify overpayments, and collaborate with clinical and claims teams to address DRG-related issues.

Key responsibilities

• Partner with Clinical, Claims, and Payment Integrity teams to review claims for DRG-related inaccuracies
• Proactively identify and recover overpayments to ensure accurate claims payments for inpatient services
• Engage in discussions with medical professionals to verify the clinical rationale behind billed procedures

Required qualifications

• CCS or CIC certification is required
• Knowledge of DRG pricing methodology is required
• At least 1 year of direct inpatient clinical coding experience is required
• Experience in Medicare or Medicare Advantage payment integrity or claims operations is preferred
• Strong computer skills in Excel and PowerPoint are necessary