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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates mastery-level expertise in APR-DRG methodology and coding, with advanced analytical skills to identify trends and root causes in large data sets. Proficient in developing audit selection criteria and ensuring compliance with regulatory standards while effectively communicating insights to senior leadership.
Highest-signal resume keywords
APR-DRG Methodology ExpertiseInpatient Coding ExperienceAdvanced Analytical SkillsAHIMA Certification (RHIA, RHIT, CCS)Encoder Tools Proficiency (3M, Trubridge)
About the role
Key responsibilities & impact- Research, analyze and generate new concepts and selection rules to identify overpayment opportunities in APR-DRG validation
- Collaborate with audit and analytic teams to review concepts before and after implementation
- Monitor concept performance and identify performance issues
- Use internal selection tools to build queries and concepts and test concept effectiveness
- Deliver results and insights to senior leaders
- Adjust selection criteria based on specific client requirements
- Perform monthly claim screening and selection
- Verify selection outputs to ensure selection rules function as intended
- Review appeals and disputes to identify areas for improvement
- Create education and training documents and conduct handoff meetings with audit teams
- Ensure the clinical team is calibrated with client policies and internal concepts
- Use Audit Outcome trend reports to monitor and fine-tune existing queries
Requirements
What you’ll need- 10+ years of inpatient coding or auditing experience with mastery-level expertise in APR-DRG methodology
- Experience developing audit selection criteria to identify APR-DRG coding errors and overpayments preferred
- Experience working with large data sets
- Ability to identify meaningful patterns, trends and root causes from data
- Advanced analytical and problem-solving skills
- Industry knowledge specific to APR-DRG reimbursement, provider contracts, payer policies, and audit regulations
- Excellent oral and written communication skills
- Bachelor’s degree in health information management, Healthcare Informatics or Health Care Administration
- Active AHIMA certification: RHIA, RHIT or CCS
- Experience with encoder tools (3M, Trubridge)
- Proficiency in Microsoft Excel, including advanced functions and pivot tables, and PowerPoint
- Experience with AI tools preferred
- Mastery-level coding skills in ICD-10-CM and PCS
- Extensive knowledge of ICD-10 Official Coding Guidelines and AHA Coding Clinic guidelines
- Advanced understanding of MS DRG and APR-DRG reimbursement methodologies
- Current knowledge of relevant regulatory changes
- A brief coding/auditing assessment may be included in the interview process
Benefits
Comp & perks- Healthcare, Vision, Dental and 401k options
- Mentoring program with guidance/coaching from senior-level professionals
- Opportunities to work with experienced, world-class healthcare consultants
- Professional and personal growth and development opportunities
- 100% remote work from home
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
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Hard Skills
ICD-10-CM CodingICD-10-PCS CodingData AnalysisAudit Selection Criteria DevelopmentQuery BuildingConcept TestingPerformance MonitoringRegulatory ComplianceTrend IdentificationRoot Cause Analysis
Soft Skills
Excellent Communication SkillsProblem-Solving SkillsCollaboration SkillsTraining and Education Development
Tools & Technologies
Microsoft ExcelMicrosoft PowerPointAI ToolsAudit Outcome Trend Reports
Certifications & Qualifications
AHIMA Certification (RHIA, RHIT, CCS)
Industry Keywords
APR-DRG ReimbursementProvider ContractsPayer PoliciesAudit RegulationsICD-10 Official Coding GuidelinesAHA Coding Clinic GuidelinesRegulatory Changes