We are seeking a Senior Inpatient DRG Coding Analyst – Payment Integrity with deep expertise in acute inpatient coding, clinical validation, and US healthcare claims auditing. In this role, you will work on complex inpatient cases for US health plans, ensuring coding accuracy, clinical integrity, and payment correctness. You will play a key role in identifying payment variances, strengthening audit defensibility, and supporting compliance initiatives. This is an excellent opportunity to move into payer-side payment integrity, working with advanced tools, data, and audit methodologies.

Key Responsibilities

Conduct end-to-end audits of acute inpatient claims covering coding accuracy, clinical validation, and DRG assignment
Validate principal and secondary diagnoses, CC/MCC capture, procedures (ICD-10-PCS), Present on Admission (POA) indicators, and final MS-DRG / APR-DRG assignment
Review medical records and provider documentation for completeness and accuracy
Apply expertise in ICD-10-CM/PCS, MS-DRG / APR-DRG methodologies, CMS guidelines, and Coding Clinic updates
Utilize encoders, DRG groupers, and claims platforms to validate payment outcomes
Apply clinical judgment and medical necessity criteria to support audit findings
Prepare clear, defensible audit documentation for internal review and appeals
Ensure compliance with CMS, HIPAA, and payer guidelines
Meet defined productivity and quality benchmarks

Required Qualifications

Education: RHIA / RHIT OR Nursing Degree with strong inpatient coding/audit experience
Experience: 3+ years in inpatient coding / DRG validation, payment integrity / claims auditing / coding QA
Hands-on experience: ICD-10-CM/PCS, MS-DRG and/or APR-DRG, acute care inpatient coding, US healthcare claims and billing workflows
Certifications (Mandatory): RHIA / RHIT, CCS (AHIMA), or CIC (AAPC)

Preferred Qualifications

Experience working with US payer-side platforms
Knowledge or hands-on experience with TriZetto (Facets, QNXT, or related modules) is a strong advantage
Exposure to post-payment audits / recovery audits, appeals and provider dispute workflows
Experience supporting US health plans / managed care organizations

Skills & Competencies

Strong expertise in inpatient coding and DRG validation
Excellent analytical and clinical reasoning skills
Ability to work independently in high-volume audit environments
High attention to accuracy and detail
Strong written communication for audit documentation
Up-to-date with US coding and regulatory changes

Why Join Us

Work on high-impact US payment integrity programs
Gain exposure to enterprise payer platforms like TriZetto
Opportunity to grow into Senior SME, Audit Lead, or Consulting roles
Be part of a quality-driven, compliance-focused team
Work with advanced healthcare data and AI-enabled platforms

Senior Inpatient DRG Coding Analyst – Payment Integrity (US Healthcare)