A leading healthcare organization is seeking experienced Senior Clinical Coders to support complex DRG validation and retrospective claims review initiatives within a highly structured clinical operations environment. This is a remote contract-to-hire opportunity with long-term potential. This is not a standard outpatient or professional fee coding role. Ideal candidates will have strong experience with:
  • Inpatient facility coding
  • DRG validation and reimbursement review
  • Retrospective claims review
  • ICD-10-CM, ICD-10-PCS, CPT, and HCPCS coding
  • Hospital/facility billing environments
  • Managed care, health plan, or healthcare audit/review settings
Requirements:
  • CIC, CCS, RHIT, or RHIA credential
  • 5+ years of clinical coding experience
  • Strong inpatient facility coding background
  • Experience with DRG-based reimbursement methodologies
  • Strong analytical and documentation review skills
  • U.S. Citizenship required
  • Ability to obtain and maintain federal clearance
  • Must reside in approved remote states: AK, AR, AZ, CO, DC, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NC, ND, NE, NM, NV, OK, OR, SC, SD, TN, TX, UT, VA, WA, WI, WY
Preferred:
  • Managed care or health insurance experience
  • Government healthcare program exposure
  • Audit, appeals, denials, or coding review experience
  • Experience supporting medical directors or quality review teams
Responsibilities:
  • Perform retrospective inpatient claims and DRG validation reviews
  • Analyze coding accuracy, reimbursement, and pricing determinations
  • Identify coding discrepancies, quality concerns, and compliance issues
  • Prepare written review outcomes and determinations
  • Support provider review, appeals, and cross-functional coding initiatives
  • Research coding guidelines, medical policy, and reimbursement standards
This is a fast-moving remote opportunity with interview activity beginning immediately. If your background aligns, please apply today or message me directly with your resume and certifications.

Also on the board Same function, level within a rung

Level

Senior

Location

New York, NY

Occupation

Health Information Technologists and Medical Registrars

Industry

All Other Miscellaneous Ambulatory Health Care Services

Posted

18 days ago

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