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
