Remote Team Lead - Auditing & DRG Claims Expert

Cohere Health; United States; Remote; USD 100,000 - 110,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Life insurance

Disability insurance

Employee Assistance Program

401K with company match

Paid parental leave

Job summary

Cohere Health is seeking a Team Lead, Auditing to guide a remote team focused on MS-DRG and ARP-DRG reviews and maximize overpayment identifications. You will mentor auditors, ensure timeliness, and produce concise audit findings grounded in ICD-10-CM/PCS and AHA guidelines.

The role requires extensive DRG auditing experience, supervisory skills in a remote setting, and credentials such as CCS/RHIA/RHIT. Strong communication and analytical abilities are essential in a fast-growth environment.

Qualifications

• 8+ years experience performing MS-DRG and ARP-DRG reviews for a Payment Integrity vendor or payer.
• 2-3 years of supervisory/management experience, including supervising and training in a remote work environment.
• CCS credential highly preferred.
• RHIA, or RHIT credential, Associate's Degree in Health Information Management, Nursing, or related field preferred.
• Preference for candidates holding both a coding credential and an HIM credential (RHIA/RHIT).
• Requires advanced expertise in ICD-10-CM/PCS coding and the ability to exercise discretion and professional judgment in assessing complex clinical information, validating diagnosis code assignments, and identifying discrepancies such as coding errors or upcoding.
• Prepares clear, concise, and well-supported audit findings, referencing authoritative sources such as AHA Coding Clinic and ICD-10 guidelines.
• Experience using CMS NCDs/LCDs and clinical criteria guidelines.
• Self-motivated and able to work independently in a remote environment while maintaining high performance.
• Consistently meets or exceeds established quality and productivity standards while managing priorities and workflow autonomously.
• Passion for DRG auditing and a commitment to teamwork, collaboration, and continuous learning.
• Excellent written and verbal communication skills, strong analytical skills, and attention to detail.
• Inpatient audits experience for case rate and per diem.
• Preference for candidates with outpatient and professional claims auditing experience.
• Experience working in a start-up or high-growth company environment, demonstrating agility and adaptability.
• Familiarity with working with a diverse, global team of talent.
• Excellent computer skills and familiarity with a Mac.

Responsibilities

• Lead and mentor a team of auditors, managing workloads and supporting professional development.
• Collaborate cross-functionally to align on production, quality review and meeting defined timelines.
• Conduct comprehensive coding reviews to ensure accuracy and reimbursement.
• Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications.
• Craft clear, concise, and well-supported audit findings, backed by AHA Coding Clinic Guidelines and ICD-10-CM/PCS regulations.
• Utilize advanced DRG encoder tools to drive efficiency and accuracy in audits.
• Meet or exceed company quality and productivity standards, including strong uphold rates for appeals.
• Stay ahead of industry trends, coding updates, and compliance regulations to maintain expert-level knowledge.
• Adhere to HIPAA and company policies and procedures to ensure data security and regulatory compliance.
• Maintain and apply knowledge of changes and updates to coding guidelines, reimbursement trends, and health payment policy language.

Skills

MS-DRG reviews

DRG auditing

Leadership

Remote supervision

Education

RHIA

RHIT

CCS

Associate's Degree in HIM

Nursing

Tools

DRG encoder tools

CMS guidelines

Job description

Cohere Health is seeking a Team Lead, Auditing to guide a remote team focused on MS-DRG and ARP-DRG reviews and maximize overpayment identifications. You will mentor auditors, ensure timeliness, and produce concise audit findings grounded in ICD-10-CM/PCS and AHA guidelines.

The role requires extensive DRG auditing experience, supervisory skills in a remote setting, and credentials such as CCS/RHIA/RHIT. Strong communication and analytical abilities are essential in a fast-growth environment.