Remote DRG Coding & Clinical Validation Analyst (I–III)

Excellus BCBS; City of Utica (NY); Hybrid; USD 65,346 - 142,322; Full time

Benefits offered by this job

Group health and dental insurance

Retirement benefits

Paid time off and holidays

Wellness programs

Job summary

A leading health insurance provider in New York is seeking a Payment Integrity DRG Coding & Clinical Validation Analyst across levels I, II, and III. Responsibilities include reviewing medical records to ensure accurate coding and leading audits. Candidates should have relevant degrees and certifications, with varying years of experience based on the level. The role offers a competitive salary range and the possibility of remote work.

Qualifications

• Three years of experience in claims auditing or quality assurance for DRG coding in a hospital setting.
• Intermediate analytical and problem-solving skills.
• Five years of experience for Level II roles; eight years for Level III roles.

Responsibilities

• Review medical records to support coding accuracy and DRG assignment.
• Conduct audits and analyze inpatient claims using coding principles.
• Lead audits and mentor team members at Level III.

Skills

ICD-10 coding expertise

Analytical skills

Problem-solving skills

Proficiency with PC and software

Education

Associate or bachelor's degree in health information management or Nursing

RHIA or RHIT credential

Inpatient Coding Credential – CCS or CIC

Tools

Auditing tools

Claims processing systems

Job description

A leading health insurance provider in New York is seeking a Payment Integrity DRG Coding & Clinical Validation Analyst across levels I, II, and III. Responsibilities include reviewing medical records to ensure accurate coding and leading audits. Candidates should have relevant degrees and certifications, with varying years of experience based on the level. The role offers a competitive salary range and the possibility of remote work.