Team Lead, DRG Auditing

Opportunity Overview:

We are seeking a Team Lead, Auditing to join our dynamic Payment Integrity team. This critical role involves leading a team of auditors (such as Inpatient, Outpatient, Professional) conducting comprehensive reviews to ensure the accuracy of claims and maximize overpayment identification. If you possess a CCS credential, a deep understanding of inpatient, outpatient and professional auditing, and a passion for deep analytical work, you will be instrumental in supporting Cohere Health’s commitment to accurate reimbursement solutions. This opportunity requires a self-motivated individual who thrives on precision, compliance, and continuous learning in a high-growth environment. 

 

What You'll Do:

• Lead and mentor a team of auditors, managing workloads and supporting professional development.
• Collaborate cross-functionally to align on production, quality review and meeting defined timelines.
• Conduct comprehensive coding reviews to ensure accuracy and reimbursement.
• Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications.
• Craft clear, concise, and well-supported audit findings, backed by AHA Coding Clinic Guidelines and ICD-10-CM/PCS regulations.
• Utilize advanced DRG encoder tools to drive efficiency and accuracy in audits.
• Meet or exceed company quality and productivity standards, including strong uphold rates for appeals.
• Stay ahead of industry trends, coding updates, and compliance regulations to maintain expert-level knowledge.
• Adhere to HIPAA and company policies and procedures to ensure data security and regulatory compliance.

• Maintain and apply knowledge of changes and updates to coding guidelines, reimbursement trends, and health payment policy language.

 

What you’ll need:

• 8 + years experience of performing MS-DRG and ARP-DRG reviews for a Payment Integrity vendor or Payer.
• 2-3 years of supervisory/management experience, including supervising and training in a remote work environment.
• CCS (Certified Coding Specialist) credential highly preferred.
• RHIA, or RHIT credential, Associate's Degree in Health Information Management, Nursing, or related field preferred.
• ​​Preference for candidates holding both a coding credential and an HIM credential (RHIA/RHIT).
• Requires advanced expertise in ICD-10-CM/PCS coding and the ability to exercise discretion and professional judgment in assessing complex clinical information, validating diagnosis code assignments, and identifying discrepancies such as coding errors or upcoding.
• Prepares clear, concise, and well-supported audit findings, referencing authoritative sources such as AHA Coding Clinic and ICD-10 guidelines, ensuring recommendations reflect professional expertise.
• Experience using CMS NCDs/LCDs and clinical criteria guidelines.
• Self-motivated and able to work independently in a remote environment while maintaining high performance.
• Consistently meets or exceeds established quality and productivity standards while managing priorities and workflow autonomously.
• Passion for DRG auditing and a commitment to teamwork, collaboration, and continuous learning.

• Excellent written and verbal communication skills, strong analytical skills, and attention to detail.

• Inpatient audits experience for case rate and per diem.
• Preference for candidates with outpatient and professional claims auditing experience. 

• Experience working in a start-up or high-growth company environment, demonstrating agility and adaptability.

• Familiarity with working with a diverse, global team of talent.

• Excellent computer skills and familiarity with a Mac.

 

 

Pay & Perks:

 

💻 Fully remote opportunity with about 5% travel

🩺 Medical, dental, vision, life, disability insurance, and Employee Assistance Program 

📈 401K retirement plan with company match; flexible spending and health savings account 

🏝️ Time Off + company holidays

👶 Up to 14 weeks of paid parental leave 

🐶 Pet insurance  

 

The salary range for this position is $100,000 to $110,000 annually; as part of a total benefits package which includes health insurance, 401k and bonus. In accordance with state applicable laws, Cohere is required to provide a reasonable estimate of the compensation range for this role. Individual pay decisions are ultimately based on a number of factors, including but not limited to qualifications for the role, experience level, skillset, and internal alignment. 

Interview Process