Job Summary:
The DRG Coding Auditor position has an extensive background in facility based coding practices, clinical documentation, and/or inpatient coding auditing. This person should have a high level of understanding in reimbursement guidelines specifically around the billing practices using MS-DRG, APR-DRG and Itemized Bill Reviews (IBR). This position is responsible for auditing inpatient medical records to evaluate issues of coding and DRG assignment accuracy to generate high quality recoverable claims for the benefit of our clients.

Why You'll Love Working at ClarisHealth

We believe our team deserves the best, and we’re proud to offer a comprehensive benefits package designed to support your success, both at work and in life. Here’s what you can look forward to:

• Medical, Dental, and Vision Insurance – Enjoy medical, dental, and vision insurance that begins on your first day, ensuring your health and wellness are always supported.
• 401(k) with Matching and Immediate Vesting – Secure your financial future with a company match and instant vesting.
• Company-Paid Short-Term Disability (STD) – Added security for unforeseen circumstances.
• Company-Paid Personal Financial Advising – Expert guidance to help manage your finances.
• New Hire Stipend – A one-time stipend to purchase home office supplies (laptop and charging cable provided by the company).
• Pet Insurance Options – Choose from two carrier options to keep your furry friends covered.
• Paid Holidays – 9 company holidays plus 2 floating holidays for added flexibility.
• Virtual Counseling and Telemedicine – Company-paid access to mental health and medical support from the comfort of your home.
• Paid Parental Leave – Time to focus on family during this special chapter.
• Generous Vacation & Wellness Time – 4 weeks of vacation beginning accrual on day one, plus 1 additional week for wellness.
• Professional Development Stipend – After one year, enjoy a $500 annual stipend to invest in professional growth (e.g., certifications, webinars).

You may be ideal if you have:

• High School Diploma / GED (or higher)?
• 3+ years of performing inpatient acute care hospital coding (may substitute equivalent years of DRG validation experience) OR 3+ years of Clinical Documentation Improvement experience (coding OR auditing)?
• 2+ years experience with APR-DRG reimbursement methodologies.
• CCS or CIC certification required.
• CPC certification or outpatient coding experience preferred.
• Experience with clinical validation in addition to DRG coding validation.
• Intermediate level of experience with the use of Microsoft applications.
• Positive, self-motivated, driven, and innovative attitude.
• High standard of personal integrity and accountability.
• Passion and aptitude for solving complex problems.

Responsibilities:

• Investigate, review, and provide coding expertise in the application of medical and reimbursement policies within the claim adjudication process through document review.
• Perform clinical coverage review of claims, which requires interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies, coding requirements and consideration of relevant clinical information on claims with aberrant billing patterns.
• Perform clinical coding review to ensure accuracy of medical coding and utilize clinical expertise and judgment to determine correct coding and billing.?
• Knowledge of and the ability to: identify the ICD-10-CM/PCS code assignment, code sequencing, and discharge disposition, in accordance with CMS requirements, Official Guidelines for Coding and Reporting, and Coding Clinic guidance.?
• Must be fluent in application of current Official Coding Guidelines and Coding Clinic citations, in addition to demonstrating working knowledge of clinical criteria documentation requirements used to successfully substantiate code assignments.
• Solid command of anatomy and physiology, diagnostic procedures, and surgical operations developed from specialized training and extensive experience with ICD-10-PCS code assignment.?
• Writes clear, accurate and concise rationales in support of findings.?
• Maintain and manage daily case review assignments, with a high emphasis on quality.
• Provide clinical support and expertise to the other investigative and analytical areas.?
• Will be working in a high-volume production environment.

Other Duties:

This job description in no way states or implies that these are the only duties to be performed by this employee. This position will be required to follow any other instructions and to perform any other duties requested by his/her supervisor. Individuals will always be expected to maintain a professional work environment.

About ClarisHealth

ClarisHealth, based in Nashville, Tenn., provides health plans and payers with a better way to drive claims payment accuracy. Its proprietary, A.I.-powered enterprise technology platform Pareo® allows health plans across the U.S. to reduce manual work, gain insights into operational performance across lines of business, and accelerate their strategy to overpayment prevention – at a significantly reduced cost.

Company Culture

Our company values help everyone move in alignment toward this mission. We are …

Compassionate. We practice servant leadership, encourage inclusion and engagement, and actively acknowledge and celebrate each other’s contributions.

Communicators. We listen first with an emphasis on understanding. We seek solutions to problems, and practice radical candor with positive intent.

Challengers. We get the right stuff done right, create clarity from complexity, take accountability and ownership, and we challenge ourselves daily.

ClarisHealth embraces a supportive working culture of creativity and innovation internally termed “Got Your Back.” We live out this #GYB spirit every day by working together with team members, clients, and other partners to achieve shared goals.

For more information about ClarisHealth and our culture, please visit us at https://www.clarishealth.com/careers/.

Other

Applicants must be currently authorized to work in the United States on a full-time basis. ClarisHealth is not able to sponsor applicants for work visas.

EOE, including Disability/Veterans; anyone needing accommodation to complete the interview process should notify the People Operations team.