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Claims Auditor - DRG

Cohere Health -
Remote

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Job Details

$72,000 - $82,000 a year

Benefits

Paid parental leave
Health savings account
Disability insurance
Health insurance
Dental insurance
401(k)
Parental leave
Employee assistance program
Vision insurance
401(k) matching
Pet insurance

Qualifications

Audit report preparation
Startup experience
Audit Reporting
Retrospective medical coding audits
Case review audits
Health insurance knowledge
Computer skills
Health information management
Quality audits
Data validation
Insurance claims auditing
Clinical documentation standards
Associate's degree
Healthcare claims compliance audits
Medical record review for billing accuracy
DRG

Full Job Description

Opportunity Overview:

We are seeking an Inpatient Auditor to join our dynamic Payment Integrity team. This critical role involves conducting comprehensive MS-DRG and APR-DRG coding reviews to ensure the accuracy of claims and maximize overpayment identification. If you possess a CCS credential, superior knowledge of ICD-10-CM/PCS coding guidelines, and a passion for deep analytical work, you will be instrumental in supporting Cohere Health's commitment to accurate reimbursement solutions. This opportunity requires a self-motivated individual who thrives on precision, compliance, and continuous learning in a high-growth environment.

What you'll do:

Conduct comprehensive MS-DRG and APR-DRG coding reviews to ensure accuracy in DRG assignment 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 superior knowledge of changes and updates to coding guidelines, reimbursement trends, and health payment policy language.

What you'll need:

3+ years experience of performing MS-DRG and ARP-DRG reviews for a Payment Integrity vendor or Payer required.
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, ensuring recommendations reflect professional expertise.
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.
Possess the CCS (Certified Coding Specialist) credential.

Excellent written and verbal communication skills, strong analytical skills, and attention to detail.

RHIA, or RHIT credential, Associate's Degree in Health Information Management, Nursing, or related field.
Inpatient audits for case rate and per diem.

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.

Pay & Perks:

Fully remote opportunity with about 5% travel

Medical, dental, vision, life, disability insurance, and Employee Assistance Program

401K retirement plan with company match; flexible spending and health savings account

️ Flex Time Off + company holidays

Up to 14 weeks of paid parental leave

Pet insurance

The salary range for this position is $72,000 to $82,000 annually; as part of a total benefits package which includes health insurance, 401k and bonus. In accordance with state applicable laws, Cohere is required to provide a reasonable estimate of the compensation range for this role. Individual pay decisions are ultimately based on a number of factors, including but not limited to qualifications for the role, experience level, skillset, and internal alignment. This role is not eligible for hire in: AK, CA, CO, HI, NY, or WA.

Interview Process*:

Connect with Talent Acquisition for a Preliminary Phone Screening

Meet your Hiring Manager!

Case Study

Interview with Subject Matter Expert

Behavioral Interview

Subject to change

About Cohere Health:

Cohere Health's clinical intelligence platform delivers AI-powered solutions that streamline access to quality care by improving payer-provider collaboration, cost containment, and healthcare economics. Cohere Health works with over 660,000 providers and handles over 12 million prior authorization requests annually. Its responsible AI auto-approves up to 90% of requests for millions of health plan members.

With the acquisition of ZignaAI, we've further enhanced our platform by launching our Payment Integrity Suite, anchored by Cohere Validate™, an AI-driven clinical and coding validation solution that operates in near real-time. By unifying pre-service authorization data with post-service claims validation, we're creating a transparent healthcare ecosystem that reduces waste, improves payer-provider collaboration and patient outcomes, and ensures providers are paid promptly and accurately.

At Cohere Health, Payment Integrity isn't just about catching errors—it's about transforming how healthcare dollars are spent to ensure accuracy, fairness, and better outcomes for everyone. By combining advanced analytics, clinical expertise, and cutting-edge technology, the team works at the intersection of healthcare and innovation to proactively identify opportunities, reduce waste, and strengthen trust between payers and providers. Joining this mission means being part of a forward-thinking organization that values curiosity, collaboration, and impact—where your work directly contributes to a more efficient healthcare system and helps ensure patients receive the right care at the right time and providers receive the right payment.

Cohere Health's innovations continue to receive industry wide recognition. We've been named to the 2025 Inc. 5000 list and in the Gartner® Hype Cycle™ for U.S. Healthcare Payers (2022-2025), and ranked as a Top 5 LinkedIn™ Startup for 2023 & 2024. Backed by leading investors such as Deerfield Management, Define Ventures, Flare Capital Partners, Longitude Capital, and Polaris Partners, Cohere Health drives more transparent, streamlined healthcare processes, helping patients receive faster, more appropriate care and higher-quality outcomes.

The Coherenauts, as we call ourselves, who succeed here are empathetic teammates who are candid, kind, caring, and embody our core values and principles. We believe that diverse, inclusive teams make the most impactful work. Cohere is deeply invested in ensuring that we have a supportive, growth-oriented environment that works for everyone.

We can't wait to learn more about you and meet you at Cohere Health!

Equal Opportunity Statement:

Cohere Health is an Equal Opportunity Employer. We are committed to fostering an environment of mutual respect where equal employment opportunities are available to all. To us, it's personal.

#LI-Remote

#BI-Remote

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