Inpatient Coder, DRG Validation

Job Description

Location: Remote (US-based)

We are seeking an Inpatient Coder, DRG Validation to review complex inpatient cases and validate MS-DRG and APR-DRG assignments across a multi-hospital acute care health system. This position is a full-time, direct hire opportunity available fully remote within the United States.

This role is best aligned for an experienced inpatient coder who wants to work the complex end of the case mix rather than routine production coding. You will validate DRG assignments on high-impact records, identify CC and MCC capture opportunities, build the coding rationale that holds up in audit defense, and partner with CDI on documentation gaps. The ideal candidate reads a chart and a grouper with equal fluency and can write a rationale that survives a RAC review.

Responsibilities:

• Perform DRG validation reviews on complex inpatient medical and surgical records
• Assign, sequence, and validate ICD-10-CM and ICD-10-PCS codes according to Official Coding Guidelines and payer requirements
• Identify CC and MCC opportunities, sequencing concerns, and DRG assignment discrepancies affecting reimbursement and case mix index
• Collaborate with CDI teams to clarify documentation gaps and support compliant physician query processes
• Conduct retrospective coding audits and document findings with supporting coding rationale
• Support external audit defense activities including RAC, MAC, CERT, and commercial payer reviews
• Prepare coding analyses, DRG trend reports, audit summaries, and reimbursement impact findings for leadership
• Review encoder and grouper logic to identify coding or software-related inconsistencies
• Monitor CMS transmittals, ICD-10 updates, IPPS changes, and coding guideline revisions affecting inpatient reimbursement
• Partner with coding leadership on quality improvement initiatives and coder education efforts
• Maintain detailed documentation supporting coding determinations and audit findings
• Support organizational compliance with coding, billing, and documentation integrity standard

Qualifications:

• Associate degree in Health Information Management or a related field required; bachelor’s degree preferred
• Active RHIA, RHIT, CCS, or CIC credential required; CCS strongly preferred
• Minimum of 3 years of inpatient coding experience required
• Experience with DRG validation, inpatient auditing, or CDI-adjacent review work preferred
• Advanced working knowledge of ICD-10-CM, ICD-10-PCS, UHDDS standards, and Official Coding Guidelines required
• Familiarity with AHA Coding Clinic guidance and inpatient reimbursement methodologies preferred
• Experience with 3M 360, 3M CAC, Optum, or comparable encoder and grouper platforms preferred
• Experience navigating Epic, Cerner, Meditech, or comparable EHR systems
• Strong analytical, documentation review, and coding rationale writing skills
• Demonstrated ability to maintain productivity and quality standards in a fully remote environment

Schedule:

• Full-time position
• Fully remote within the United States
• Monday through Friday, standard business hours
• Flexible scheduling within operational needs

Salary Range:

The salary range for this position is approximately $80,000 – $95,000 annually ($38.46 – $45.67 per hour), based on experience and qualifications.

Interview Process:

Selected candidates will participate in a multi-step interview process, including an initial screening with TalentLNX followed by interviews with department leadership.

Equal Opportunity Employer: TalentLNX is committed to equal employment opportunity and a diverse, inclusive workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.