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.
