Senior Claims Auditor - DRG

3+ years experience of performing MS-DRG and ARP-DRG reviews for a Payment Integrity vendor or Payer required.

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.

Passion for DRG auditing and a commitment to teamwork, collaboration, and continuous learning.

Inpatient audits for case rate and per diem.

Conduct comprehensive MS-DRG and APR-DRG coding reviews to ensure accuracy in DRG assignment 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.

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.

Cohere Health’s clinical intelligence platform delivers AI-powered solutions that streamline access to quality care by improving payer-provider collaboration, cost containment, and healthcare economics. Cohere Health works with over 660,000 providers and handles over 12 million prior authorization requests annually. Its responsible AI auto-approves up to 90% of requests for millions of health plan members.

With the acquisition of ZignaAI, we’ve further enhanced our platform by launching our Payment Integrity Suite, anchored by Cohere Validate™, an AI-driven clinical and coding validation solution that operates in near real-time. By unifying pre-service authorization data with post-service claims validation, we’re creating a transparent healthcare ecosystem that reduces waste, improves payer-provider collaboration and patient outcomes, and ensures providers are paid promptly and accurately.

At Cohere Health, Payment Integrity isn’t just about catching errors—it’s about transforming how healthcare dollars are spent to ensure accuracy, fairness, and better outcomes for everyone. By combining advanced analytics, clinical expertise, and cutting-edge technology, the team works at the intersection of healthcare and innovation to proactively identify opportunities, reduce waste, and strengthen trust between payers and providers. Joining this mission means being part of a forward-thinking organization that values curiosity, collaboration, and impact—where your work directly contributes to a more efficient healthcare system and helps ensure patients receive the right care at the right time and providers receive the right payment.

Cohere Health’s innovations continue to receive industry wide recognition. We’ve been named to the 2025 Inc. 5000 list and in the Gartner® Hype Cycle™ for U.S. Healthcare Payers (2022-2025), and ranked as a Top 5 LinkedIn™ Startup for 2023 & 2024. Backed by leading investors such as Deerfield Management, Define Ventures, Flare Capital Partners, Longitude Capital, and Polaris Partners, Cohere Health drives more transparent, streamlined healthcare processes, helping patients receive faster, more appropriate care and higher-quality outcomes.

The Coherenauts, as we call ourselves, who succeed here are empathetic teammates who are candid, kind, caring, and embody

our core values and principles