DRG Integrity Analyst

The DRG Integrity Analyst (DIA) serves as the first line of clinical and coding review for inpatient encounters, evaluating client charts to identify opportunities to adjust the assigned Diagnosis Related Group (DRG). This role conducts high-level assessments to detect DRG risk, optimization opportunities, and documentation or coding misalignment — advancing only cases with actionable recommendations to Clinical Coding Analysts (CCAs). Dedicated exclusively to DRG validation workflows, this position is foundational to efficient, targeted, and high-yield chart review operations, ensuring alignment with clinical validity, coding guidelines, and revenue integrity principles.

ESSENTIAL JOB DUTIES AND RESPONSIBILITIES

Perform initial DRG-focused screening of all assigned inpatient charts in accordance with established workflows and protocols Conduct high-level clinical and coding assessments to identify DRG risk, optimization opportunities, and documentation or coding misalignment Evaluate key DRG drivers — including principal diagnosis, principal procedures, CC/MCCs, clinical indicators, and sequencing — to determine case-level opportunity Triage cases presenting with potential DRG shifts, missed or unsupported CC/MCCs, documentation gaps affecting DRG assignment, or coding and sequencing concerns requiring further review Advance charts with validated opportunity to Clinical Coding Analysts (CCAs) for detailed analysis and recommendation development Apply screening criteria, clinical logic, and DRG methodology consistently to sustain accuracy, quality, and productivity standards Document screening outcomes and escalation or exclusion rationale clearly to support downstream efficiency and audit defensibility Meet required productivity benchmarks while maintaining compliance with clinical validity standards and coding guidelines Collaborate with CCAs and leadership to align on best practices, workflow objectives, and quality expectations Identify and communicate recurring trends, risk patterns, and workflow barriers to leadership to drive continuous process improvement

MINIMUM REQUIRED QUALIFICATIONS

• Minimum one year of experience with inpatient coding and/or inpatient clinical documentation integrity required
• Working knowledge of MS-DRG and/or APR-DRG methodology, including CC/MCC capture, principal diagnosis selection, and procedure-driven DRG assignment
• Experience reviewing inpatient medical records within established workflows and productivity expectations

REQUIRED CERTIFICATION

(S):

• AHIMA (CCS, RHIT, RHIA, or CDIP) or ACDIS (CCDS) credential

REQUIRED SKILLS

• Ability to perform high-level clinical and coding assessments across a variety of inpatient case types
• Strong attention to detail with the ability to follow structured, repeatable workflows
• Ability to apply

ICD-10-CM/PCS

coding guidelines and Official Coding Guidelines at a screening and triage level

• Strong written documentation skills with the ability to clearly articulate screening rationale and escalation decisions
• Ability to work independently in a remote environment while meeting quality, accuracy, and productivity standards
• Strong time management, organizational, and prioritization skills
• Verbal and written communication skills
• Analytical ability
• Team leadership, including experience in highly effective change-management
• Presentation skills required to effectively communicate material to all levels of management
• Strategic relationship building
• Organization and prioritization skills
• Must possess a high degree of integrity and trust along with the ability to work independently
• Excellent oral and written communication skills required
• Must demonstrate analytical ability, initiative, and resourcefulness
• Ability to assess situations, uncover problems, identify solutions, and make decisions
• Excellent planning and organizational skills 3
• Excellent documentation skills
• Teamwork and flexibility required

PHYSICAL DEMANDS AND WORK ENVIRONMENT

This is a full-time, exempt salary position with general working hours of Monday through Friday and is designed to cover a standard work week, which typically includes 40 hours, and is not solely dependent on producing specific results if the schedule dictates otherwise. Required start times are no later than 8:00 a.m. ET/CT or 7:00 a.m. MT/PT based on the time zone in which you reside.

• Overall physical workload is light
• Ability to communicate both orally and in writing
• Sometimes work is generally sedentary requiring long periods at workstation

HOME OFFICE REQUIREMENTS

• Must have a dedicated, secure workspace to ensure adherence to HIPAA Privacy and Security policies and procedures when viewing Protected Health Information (PHI)
• High-speed internet connection
• Telephone

BENEFITS

• We are Great Place to Work Certified
• Competitive salary
• Full benefits (medical, vision, dental)
• 401(k) match o 100% on the first 3% o 50% on the next 2%
• Excellent PTO package plus 8 paid holidays
• Work 100% remote
• Laptop and other necessary equipment provided
• Employee Wellness and Discount programs
• "White glove" onboarding