Remote DRG Dispute Auditor | Medical Coding & Validation

Rawlings Company; United States; Remote; USD 100,000 - 115,000; Full time

Benefits offered by this job

Medical/Dental/Vision

401(k) with company match

Tuition reimbursement

Flexible, remote-friendly environment

Job summary

Machinify, a leading healthcare intelligence company, is seeking a DRG Dispute Reviewer to evaluate appeals and audit findings, determine DRG assignments, and ensure compliant reimbursement. You will apply MS-DRG and APR-DRG methodologies, review inpatient records, and prepare defensible rationales.

Ideal candidates have 3+ years inpatient coding, relevant certifications (RHIA/RHIT/CCS/CIC/CDIP/CCDS), strong analytical skills, and ability to work remotely from anywhere in the US.

Qualifications

• Active nursing license or health information management degree.
• Formal credentials in health information (RHIA/RHIT/CCS/CIC/CDIP or CCDS) preferred.
• Inpatient coding experience with IPPS payment knowledge.

Responsibilities

• Dispute Review: validate or revise DRG determinations from provider appeals and audits.
• Medical Record Analysis: review inpatient records and UB-04s for accurate DRG assignments.
• DRG Validation: apply MS-DRG/APR-DRG logic to support determinations.
• Written Justification: craft evidence-based rationales for clients and payers.
• Coding Expertise: maintain up-to-date ICD-10-CM/PCS guidelines and updates.
• Compliance: adhere to HIPAA and AHIMA coding standards.

Skills

ICD-10-CM/PCS coding

MS-DRG/APR-DRG methodologies

Analytical thinking

Clinical documentation

Remote work ability

Education

Associate or Bachelor’s in Nursing or Health Information Management

Tools

TruCode

3M Encoder

Excel

Word

Outlook

Teams

Job description

Machinify, a leading healthcare intelligence company, is seeking a DRG Dispute Reviewer to evaluate appeals and audit findings, determine DRG assignments, and ensure compliant reimbursement. You will apply MS-DRG and APR-DRG methodologies, review inpatient records, and prepare defensible rationales.

Ideal candidates have 3+ years inpatient coding, relevant certifications (RHIA/RHIT/CCS/CIC/CDIP/CCDS), strong analytical skills, and ability to work remotely from anywhere in the US.