Remote DRG Dispute Reviewer - Coding & Validation Expert

Work Whisper; United States; Remote; USD 100,000 - 115,000; Full time

Benefits offered by this job

Work from anywhere in the US

Top Medical/Dental/Vision

FSA/HSA

Tuition reimbursement

401(k) with company match

Wellness benefits

Job summary

Machinify, a leading healthcare intelligence company, seeks a DRG Dispute Reviewer to evaluate provider appeals and audit findings for correct MS-DRG/APR-DRG outcomes. You will apply coding guidelines and clinical validation to ensure defensible decisions across health plans.

Remote role supporting HIPAA compliant processes; in inpatient DRG expertise and strong documentation skills are essential to drive compliant reimbursements and reduce overpayments.

Qualifications

• Expert-level knowledge of MS-DRG/APR-DRG methodologies and coding guidelines.
• Strong analytical and critical thinking for complex DRG reviews.
• Ability to write clear, professional rationales supported by evidence.

Responsibilities

• Dispute Review: Evaluate provider-submitted appeals and audit findings.
• Medical Record Analysis: Review inpatient records and UB-04s for proper DRG assignment.
• DRG Validation: Apply MS-DRG/APR-DRG logic to support or overturn findings.
• Written Justification: Prepare concise rationales for clients or payers.
• Coding Expertise: Maintain knowledge of ICD-10-CM/PCS guidelines and AHIMA updates.
• Compliance: Ensure HIPAA and regulatory standards are met.

Skills

MS-DRG/APR-DRG

ICD-10-CM/PCS

Medical record analysis

Remote work

Documentation justification

Education

Nursing degree (RN) or Health Information Management degree

Tools

TruCode Encoder

3M Encoder

Job description

Machinify, a leading healthcare intelligence company, seeks a DRG Dispute Reviewer to evaluate provider appeals and audit findings for correct MS-DRG/APR-DRG outcomes. You will apply coding guidelines and clinical validation to ensure defensible decisions across health plans.

Remote role supporting HIPAA compliant processes; in inpatient DRG expertise and strong documentation skills are essential to drive compliant reimbursements and reduce overpayments.