Inpatient Coder, DRG Validation

Job Description

Location: Remote (US-based)

We are seeking an Inpatient Coder, DRG Validation to support complex inpatient coding review and DRG validation activities across a multi-hospital acute care health system. This role is responsible for reviewing high-impact inpatient cases, validating MS-DRG and APR-DRG assignments, supporting audit defense efforts, and collaborating with CDI and coding teams to improve coding accuracy and reimbursement integrity.

This position is ideal for an experienced inpatient coding professional who enjoys complex case review, reimbursement analysis, and working closely with clinical documentation and compliance teams in a highly analytical environment.

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/MCC opportunities, sequencing concerns, and DRG assignment discrepancies impacting reimbursement and case mix
• 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 payer reviews
• Prepare coding analyses, DRG trend reports, audit summaries, and reimbursement impact findings for leadership review
• Review encoder and grouper logic to identify coding or software-related inconsistencies
• Monitor CMS transmittals, ICD-10 updates, IPPS changes, and coding guideline revisions impacting inpatient reimbursement
• Partner with coding leadership on quality improvement initiatives and coding education efforts
• Maintain detailed documentation supporting coding determinations and audit findings
• Support organizational compliance with coding, billing, and documentation integrity standards

Qualifications:

• Active RHIA, RHIT, CCS, or CPC-H 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 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 similar encoder and grouper platforms preferred
• Experience navigating Epic, Cerner, Meditech, or comparable EHR systems
• Strong analytical, documentation review, and coding rationale communication skills
• Ability to work independently within a fully remote environment while maintaining productivity and quality expectations

Schedule:

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

Salary Range: The salary range for this position is approximately $55,000 – $72,000 annually ($26.44 – $34.62 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.