Top 6456 Ccs Jobs | SimplyHired

CDI DRG Downgrade Specialist- Remote
Med-Metrix —Remote
- Full-time
- Remote
- Nursing
- RN License
- HIPAA
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Clinical Documentation Specialist
Managed Resources, Inc (MRI) —Remote
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- Anatomy knowledge
- RN License
- Mid-level
- Paid holidays
- Health insurance
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Coder Professional-3
Sarah Bush Lincoln Health Systems —Illinois
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Clinical Documentation Integrity Auditor
Professional Credit Service —Remote
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- Nursing
- Writing skills
- 3 years
- Health insurance
- Dental insurance
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Clinical Documentation Specialist Audit Coordinator (Remote)
Trinity Health —Livonia, MI
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- RN License
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Coding Specialist-Clinics
La Paz Regional Hospital & Clinics —Remote
- $19 - $26 an hour
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- Anatomy knowledge
- Ability to walk for extended periods
- Computer literacy
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Documentation Specialist
Pinnacle Home Care —Remote
- Full-time
- HIPAA
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- Microsoft Office
- Referral program
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Medical Coder - ED ( 1099 )
Pena4 Inc. —Remote
- Part-time
- Remote
- Mid-level
- US work authorization
- Flexible schedule
Quick Apply
6d
Coding Specialist
Revenue Cycle Coding Strategies, LLC —Remote
- $23 - $25 an hour
- Full-time
- Remote
- Anatomy knowledge
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Medical Coder
MedHQ, LLC —Remote
- Full-time
- Mid-level
- Analysis skills
- US work authorization
- Health insurance
- Dental insurance
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Coder II
MUSC —South Carolina
- Part-time
- Remote
- Mid-level
- Analysis skills
- Associate's degree
PRN Professional Fee Coder
Santiam Hospital & Clinics —Remote
- $22.59 - $33.47 an hour
- PRN
- Hybrid work
- Customer service
- HIPAA
- Mid-level
- Paid holidays
- Disability insurance
Quick Apply
Coding Specialist
Infinx —Remote
- $19 - $22 an hour
- Full-time
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- Word processing
- Research
- Mid-level
- Paid holidays
- Health insurance
Quick Apply
Coder II, Outpatient Professional Services, Fully Remote
Southern Illinois Healthcare —Illinois
- $22.74 - $35.25 an hour
- Full-time
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- Research
- Mid-level
- High school diploma or GED
- Continuing education credits
Coding Specialist - 3147/Remote - Full Time
Wilmington Health PLLC —Wilmington, NC
- Full-time
- Remote
- Anatomy knowledge
- HIPAA
- Research
Coding Specialist
Infinx —Remote
- $25 - $30 an hour
- Full-time
- Remote
- Research
- Mid-level
- 3 years
- Paid holidays
- Health insurance
Quick Apply
Compliance Audit / Investigator - CCS / CPC / or CCA
MedStar Health —Washington, DC
- $65,062 - $117,291 a year
- Full-time
- Microsoft Outlook
- HIPAA
- Research
- Health insurance
HIM Clinical Document Specialist, Hybrid
University of Maryland Medical System —Bel Air, MD
- $38.67 - $58.05 an hour
- Full-time
- Nursing
- Senior level
- Associate's degree
Coding Quality Review Specialist -Inpatient (CCS Required)
MedStar Health —Maryland
- $31.28 - $56.39 an hour
- Full-time
- Remote
- Anatomy knowledge
- Computer literacy
- Mid-level
9d
School Speech-Language Pathologist- CCs
Life Care Center of West Bridgewater —West Bridgewater, MA
- Up to $55 an hour
- Full-time
- Background check
- CPR Certification
- Microsoft Excel
- Paid training
- Continuing education credits
Quick Apply

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CDI DRG Downgrade Specialist- Remote

Med-Metrix -
Remote

Apply Now

Job Details

Full-time
7 days ago

Qualifications

Appeals
Inpatient experience
RN License
Bachelor's degree
Clinical information systems
MFA
Bachelor's degree in nursing
Productivity software
Clinical documentation standards

Full Job Description

Job Purpose
The Clinical Documentation Integrity DRG Downgrade Specialist is responsible for reviewing, analyzing, and responding to payer initiated DRG downgrades. The Clinical Documentation Integrity DRG Downgrade Specialist ensures accurate DRG assignment, protects revenue integrity, and supports compliant documentation practices through detailed review, appeal preparation, and performance tracking. The Clinical Documentation Integrity DRG Downgrade Specialist serves as an effective change agent, acting as a resource and educator for providers and interdisciplinary care teams to improve documentation quality, coding accuracy, and audit readiness.

Duties & Responsibilities

Analyze payer DRG downgrade notifications to determine validity based on ICD 10 CM/PCS coding guidelines, clinical indicators, and documentation sufficiency
Conduct comprehensive medical record reviews to validate principal diagnosis, secondary diagnoses, procedures, MCC/CC capture, and DRG assignment accuracy
Write clear, persuasive, evidence based appeal letters that incorporate clinical rationale, coding guidelines, and regulatory references to support the original DRG
Submit appeals within required timelines and track each case through all stages of the appeal lifecycle, including initial review, reconsideration, and final determination
Maintain detailed logs of downgrade cases, outcomes, appeal success rates, and turnaround times to support throughput monitoring, trend analysis, and performance reporting
Identify patterns in payer downgrades and escalate systemic issues or documentation vulnerabilities to leadership
Collaborate with internal teams and providers to clarify ambiguous documentation and ensure clinical specificity
Identify documentation gaps or inconsistencies and provide targeted feedback to improve provider documentation practices
Participate in internal audits, retrospective reviews, and quality assurance processes related to DRG validation, coding accuracy, and documentation completeness
Assist in developing or refining documentation templates, provider education materials, and query processes to support ongoing CDI improvement
Ensure all coding and documentation practices align with CMS regulations, AHA Coding Clinic guidance, and organizational compliance policies
Stay current on payer audit trends, regulatory updates, DRG methodology changes, and emerging risk areas that may impact DRG assignment or audit outcomes
Support compliance initiatives by identifying potential vulnerabilities and recommending corrective actions or process improvements
Partner with internal teams to resolve complex DRG issues and ensure alignment across departments
Participate in provider education sessions, meetings, and case reviews to promote accurate documentation and DRG integrity
Communicate effectively with leadership regarding trends, risks, and opportunities for improvement in documentation and coding practices
Serve as a subject matter expert for DRG downgrade processes, providing guidance and support to internal teams
Other duties as assigned
Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
Understand and comply with Information Security and HIPAA policies and procedures at all times
Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties

Qualifications

Bachelor’s degree in Nursing required
Minimum of 3 years of experience in an inpatient clinical documentation improvement role
Minimum of 5 years nursing experience in adult acute care in medical/surgical, critical care, emergency, and/or PACU setting
RN license required
CCDS and/or CDIP required
CCS or CIC certification required
Demonstrated inpatient coding experience in an acute care setting
Prior experience managing DRG downgrades, including appeal letter development.
Deep knowledge of ICD-10-CM/PCS, ICD-10 Official Coding Guidelines and both MS and APR DRG Reimbursement Systems
Ability to interpret complex clinical documentation across multiple specialties.
Proficiency with EMR systems, encoder tools (e.g., 3M, Optum) and CDI workflow and reporting tools
Proficiency in Microsoft Office Suite
Strong interpersonal skills, ability to communicate well at all levels of the organization
Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses
High level of integrity and dependability with a strong sense of urgency and results oriented
Excellent written and verbal communication skills required

Working Conditions

Ability to work outside of normal business hours as needed
Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes
Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear
Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress
Work Environment: The noise level in the work environment is usually minimal

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.

Work Location: Remote

Apply Now

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