Job Details

Job Title: Clinical Coder Job ID: 74330 Location: Various US States - Fully Remote Overview: Under the direction of the DRG Supervisor or designee, conducts coding review of prior authorization requests for unlisted codes or services; retrospective medical claims review for coding and pricing determinations; and/or coding review for inpatient (facility) claims to include diagnosis and procedural coding with DRG assignment. What you will be doing:

• Provides coding-related information to medical directors, providers, peer reviewers, Claims Administration, Program Integrity, Quality Management and the claims subcontractor as needed.
• Develops determination letters.
• Provides support to non-clinical and clinical staff on coding and pricing and retrospective medical claims review processes.