In this role, the clinician educates and coaches DRG auditors, clinical reviewers, coders, and CDI teams on DRG validation, ICD-10-CM/PCS coding guidelines, and inpatient/outpatient audit workflows. The work centers on improving coding accuracy, audit consistency, and clinical documentation quality through onboarding, ongoing education, and quality trend review. The position also supports claims reviews, quality audits, and appeals while partnering with operations and leadership on continuous improvement.
Key Responsibilities
- Develop and deliver training programs for DRG auditors, coders, clinicians, physicians, and CDI teams.
- Create and maintain education materials, presentations, webinars, and other training content.
- Serve as a subject matter expert on DRG validation, APR-DRG, MS-DRG, and ICD-10-CM/PCS coding guidelines.
- Mentor and coach clinical teams to improve audit accuracy, coding quality, and compliance.
- Analyze quality trends and training needs, then provide targeted education and process improvements.
- Monitor quality metrics and update training content to align with coding guidelines, regulations, and clinical policies.
- Support clinical claim reviews, quality audits, and appeals as needed.
- Maintain documentation of training activities and accreditation-related requirements.
Required
- Associate degree in Health Information Management, Nursing, Clinical Sciences, or a related healthcare field.
- Active, unencumbered Registered Nurse license.
- One or more inpatient coding certifications such as CCS, CIC, CCDS, CDIP, CPMA, RHIA, or RHIT.
- At least 5 years of experience in inpatient claims auditing, quality assurance, or clinical documentation integrity.
- At least 5 years of experience with DRG validation audits and inpatient coding, including APR-DRG and MS-DRG.
- At least 5 years of professional medical coding experience supporting education, training, quality review, and audit activities.
Preferred
- Bachelor’s degree in a healthcare-related field.
- Experience developing education programs related to healthcare policy, Medicare guidelines, and state regulation research.
- Experience with inpatient hospital and outpatient facility coding and billing rules.
- Experience identifying overpayments, underpayments, or other revenue opportunities through clinical claim review audits.
Benefits & Perks
- Remote work within the U.S.
- Flexible hours and work-life balance support.
- Benefits effective on day 1 for eligible employees.
- Flexible vacation policy for salaried, full-time employees.
- 401(k) employer match.
- Comprehensive health benefits.
- Educational assistance and career development opportunities.
- Leadership and technical development academies.