DRG Dispute Reviewer
Remote · USFull-time$100–115K/yrSeen todaySeen in employer's feed today
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Requirements
Credentials this posting asks for.
Job overview
The DRG Dispute Reviewer evaluates provider appeals and audit findings to determine appropriate DRG assignments and payment outcomes. The role reviews inpatient records, applies clinical validation and coding principles, and prepares evidence-based rationales. It supports compliance, overpayment recovery, and accurate reimbursement, while collaborating with audit teams and communicating results to clients. The position requires inpatient coding and DRG validation experience, relevant education or equivalent experience, and one of several coding or documentation credentials.
Skills & qualifications
Skills
Qualifications
Benefits
Full job description
Experience Required
3 - 20 years
Minimum Education Required
Bachelor's Degree
Compensation
$100,000.00 - $115,000.00 / yearly
Hours Per Week
40
Number Of Positions
1
Work Schedule and Shift Requirements
First (Day)
Job Description
Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. We're constantly reimagining what's possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.
About the Opportunity
The DRG Dispute Reviewer is responsible for evaluating provider appeals and original audit findings to determine the correct DRG assignment and payment outcome. This role requires advanced knowledge of MS-DRG and APR-DRG methodologies, clinical validation, coding guidelines, and payer policies. Using clinical and coding expertise, the reviewer independently assesses documentation to ensure audit decisions are accurate, defensible, and compliant. This position plays a vital role in supporting regulatory compliance, identifying and recovering overpayments, and promoting proper documentation and reimbursement practices across healthcare systems.
Duties and Responsibilities
Dispute Review: Evaluate provider-submitted appeals and original audit findings to validate or revise DRG determinations.
Medical Record Analysis: Review inpatient medical records, UB-04s, and documentation to ensure correct DRG assignment and adherence to coding, billing, and payment guidelines.
DRG Validation: Apply clinical validation and coding principles to support or overturn DRG audit findings using MS-DRG and APR-DRG grouping logic.
Written Justification: Prepare clear, concise, and evidence-based rationales to support determinations for clients, providers, or payers.
Coding Expertise: Maintain expert knowledge of ICD-10-CM/PCS coding guidelines, UHDDS definitions, and AHA Coding Clinic updates.
Clinical Judgment: Use clinical acumen to assess medical necessity, documentation sufficiency, and code assignment accuracy.
Collaboration: Work closely with audit leads and team members to ensure consistency and quality in dispute resolutions.
Quality & Productivity: Meet performance standards for accuracy, timeliness, and productivity in dispute review and audit completion.
Compliance: Adhere to HIPAA guidelines, industry best practices, and AHIMA's Standards of Ethical Coding.
Client Communication: Participate in client meetings, including presenting audit results when required.
Tool Utilization: Use proprietary audit platforms, encoders, and medical record systems efficiently and effectively.
Other Duties: Perform additional tasks as assigned to support audit operations and client needs.
What You Bring
Required Education (One of the following):
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.
Required Certifications (At least one of the following):
RHIA - Registered Health Information Administrator
RHIT - Registered Health Information Technician
CCS - Certified Coding Specialist
CIC - Certified Inpatient Coder
CDIP or CCDS - Clinical Documentation Improvement certification
Experience:
Minimum 3 years of inpatient hospital coding (IPPS reimbursement)
Minimum 4 years DRG validation (clinical and coding)
Experience in DRG dispute reviews, clinical validation, and recovery audits strongly preferred
Prior experience in inpatient clinical documentation integrity (CDI) is a plus
Skills and Competencies:
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
Technically proficient with:
Medical record systems and audit platforms
Encoder/grouper tools (e.g., TruCode, 3M)
Microsoft Office Suite (Excel, Word, Outlook, Teams)
What We Offer
Work from anywhere in the US! Machinify is digital-first.
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
The salary for this position is based on an array of factors unique to each candidate: Such as years and depth of experience, set skills, certifications, etc. We are hiring for different levels, and our Recruiting team will let you know if you qualify for a different role/range.
Pay range: $100,000 - $115,000, with eligibility for quarterly bonuses.
Equal Employment Opportunity at Machinify
We are committed to equal employment opportunity regardless of r ace, color, ancestry, r eligion, s ex, national origin, s exual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace. Machinify is an employment at will employer. We participate in E-Verify as required by applicable law. In accordance with applicable state laws, we do not inquire about salary history during the recruitment process. If you require a reasonable accommodation to complete any part of the application or recruitment process, please let our recruiters know. See our Candidate Privacy Notice at:https://www.machinify.com/candidate-privacy-notice/
Equal Opportunity Employer
Veteran Friendly Employer
Job Type
Full time
Benefits Offered
Not specified
Veteran Preference
No
Place of Work
On-site
Requisition ID
4224491009
How this job compares
Set against the 358 open Medical Coder jobs on Olive Jobs, counted November 7, 2026.
- Pay
- This posting$100–115K/yr
- US median$56–94K/yr72 salary ranges
This range's midpoint, $108K, is 53% above the US median midpoint ($70K) — in the top quarter of Medical Coder salary ranges across the US.
- Openings
- Olive Jobs lists 358 open Medical Coder jobs across the US. 48% of them nationwide are listed as remote or flexible.
- Hiring the most across the US
- UnitedHealth Group30 open
- CVS Health24 open
- Houston Methodist14 open
- Experience
- This posting asks for at least 3 years of experience; Medical Coder postings that state a minimum ask for 3 years at the median (289 postings).
- Education
- 2 of the 358 open Medical Coder jobs (under 1%) ask for a bachelor's degree or higher.
Counted across the open, public US postings on Olive Jobs on November 7, 2026. Pay medians are the middle values of the low ends and of the high ends of postings that list both ends of a range in the same cadence (a yearly salary or an hourly rate); a range's midpoint is halfway between its ends. Pay and experience figures resting on fewer than 20 postings are left out.
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