DRG Dispute Reviewer

Machinify

. Evaluate provider-submitted appeals and original audit findings to validate or revise DRG determinations .

Posted 11/6/2026full-timeRemote • United StatesMid-LevelSenior💰 $100,000 - $115,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expert-level knowledge of ICD-10-CM/PCS coding systems and MS-DRG/APR-DRG methodologies, with strong analytical skills for evaluating clinical documentation and coding compliance. Proficient in preparing evidence-based rationales and adhering to HIPAA guidelines while maintaining high accuracy and productivity standards.

Highest-signal resume keywords

ICD-10-CM/PCS CodingMS-DRG/APR-DRG MethodologiesRHIA/RHIT/CCS/CIC/CDIP/CCDS CertificationInpatient Hospital Coding ExperienceDRG Validation Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical ValidationCoding PrinciplesDRG AssignmentAudit Findings EvaluationDocumentation Assessment

Soft Skills

Analytical SkillsCritical ThinkingAttention to DetailProfessional Writing

Tools & Technologies

TruCode3M Encoder/GrouperMicrosoft Office SuiteAudit PlatformsMedical Record Systems

Certifications & Qualifications

RHIARHITCCSCICCDIPCCDS

Industry Keywords

DRG ValidationInpatient Clinical Documentation IntegrityHIPAA ComplianceUHDDS DefinitionsAHA Coding Clinic Updates

About the role

Key responsibilities & impact

Evaluate provider-submitted appeals and original audit findings to validate or revise DRG determinations
Review inpatient medical records, UB-04s, and documentation for correct DRG assignment and compliance with coding, billing, and payment guidelines
Apply clinical validation and coding principles using MS-DRG and APR-DRG grouping logic
Prepare clear, concise, evidence-based rationales for clients, providers, or payers
Maintain expert knowledge of ICD-10-CM/PCS coding guidelines, UHDDS definitions, and AHA Coding Clinic updates
Assess medical necessity, documentation sufficiency, and code assignment accuracy
Collaborate with audit leads and team members on dispute resolution quality and consistency
Meet accuracy, timeliness, and productivity standards
Adhere to HIPAA guidelines, industry best practices, and AHIMA’s Standards of Ethical Coding
Participate in client meetings and present audit results when required
Use proprietary audit platforms, encoders, and medical record systems
Perform additional tasks supporting audit operations and client needs

Requirements

What you’ll need

An associate or bachelor’s degree in nursing (active/unrestricted license), or in health information management is required
Work experience may be considered in lieu of formal education at leadership discretion
At least one required certification: RHIA, RHIT, CCS, CIC, CDIP, or CCDS
Minimum 3 years of inpatient hospital coding (IPPS reimbursement)
Minimum 4 years DRG validation (clinical and coding)
Expert-level knowledge of ICD-10-CM/PCS coding systems, MS-DRG/APR-DRG methodologies, and official guidelines
Strong analytical and critical thinking skills for complex case reviews
Ability to write clear, professional rationales supported by clinical and coding evidence
High attention to detail, accuracy, and compliance
Able to work independently with minimal supervision in a remote environment
Technical proficiency with medical record systems and audit platforms
Technical proficiency with encoder/grouper tools such as TruCode and 3M
Proficiency with Microsoft Office Suite, including Excel, Word, Outlook, and Teams
Experience in DRG dispute reviews, clinical validation, and recovery audits strongly preferred
Prior experience in inpatient clinical documentation integrity (CDI) is a plus

Benefits

Comp & perks

Work from anywhere in the US
Top Medical/Dental/Vision offerings
FSA/HSA
Tuition reimbursement
Competitive salary
401(k) with company match
Additional health and wellness benefits and perks
Flexible and trusting environment where you’ll feel empowered to do your best work
Eligibility for quarterly bonuses