27 drg validation coding auditor jobs found

Inpatient Facility Medical Coder To independently and efficiently perform the responsibilities assigning accurate diagnosis and procedures codes to the patients health information records for: Emergency Department (ED), Ambulatory Surgical Center (ASC), Hospital Ambulatory Surgical Center (HAS), Observations (OBS), Inpatient (IP) and other selected facility records. Maintain an acceptable level of performance in quality and productivity for ICD-10-CM, ICD-10-PCS, and HCPCS/CPT classification and nomenclature systems. All work will be carried out in accordance with the: International Classification of Diseases - Official Coding Guidelines for coding and reporting as established by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS); American Medical Association (CPT); National Correct Coding Initiative (NCCI); Uniform Hospital Discharge Data Set (UHDDS), Medicaid (OMAP), and Kaiser Permanente organization/institutional coding...

JOB DESCRIPTION To independently and efficiently perform the responsibilities assigning accurate diagnosis and procedures codes to the patients health information records for: Emergency Department (ED), Ambulatory Surgical Center (ASC), Hospital Ambulatory Surgical Center (HAS), Observations (OBS), Inpatient (IP) and other selected facility records. Maintain an acceptable level of performance in quality and productivity for ICD-10-CM, ICD-10-PCS, and HCPCS/CPT classification and nomenclature systems. All work will be carried out in accordance with the: International Classification of Diseases - Official Coding Guidelines for coding and reporting as established by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS); American Medical Association (CPT); National Correct Coding Initiative (NCCI); Uniform Hospital Discharge Data Set (UHDDS), Medicaid (OMAP), and Kaiser Permanente organization/institutional coding...

OP Coder Auditor Trainee Facility Prime Healthcare Management Inc Location US-CA-Ontario ID 2026-245853 Category Business Professional Position Type Full Time Shift Days Job Type Non-Exempt Overview Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 51 hospitals and has more than 360 outpatient locations in 14 states providing more than 2.5 million patient visits annually. It is one of the nation's leading health systems with nearly 57,000 employees and physicians. Eighteen of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team! Responsibilities The Outpatient Coder Auditor Trainee reviews and analyzes documentation present in the medical record for outpatient visits to ensure accuracy of diagnosis and procedure codes assigned by the Coders or...

Candidates must reside either in Washintgon or Oregon to be considered for this position. To independently and efficiently perform the responsibilities assigning accurate diagnosis and procedures codes to the patients health information records for: Emergency Department (ED), Ambulatory Surgical Center (ASC), Hospital Ambulatory Surgical Center (HAS), Observations (OBS), Inpatient (IP) and other selected facility records. Maintain an acceptable level of performance in quality and productivity for ICD-10-CM, ICD-10-PCS, and HCPCS/CPT classification and nomenclature systems. All work will be carried out in accordance with the: International Classification of Diseases - Official Coding Guidelines for coding and reporting as established by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS); American Medical Association (CPT); National Correct Coding Initiative (NCCI); Uniform Hospital Discharge Data Set (UHDDS), Medicaid...

Must Haves 2+ years of working with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG with a broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, medical necessity criteria, and coding terminology. Expert coding knowledge (DRG & ICD-10) Registered Nurse RN (must be inpatient) WITH coding/clinical documentation certification (2 years in clinical documentation) Day to Day Insight Global is seeking a DRG Validation Auditor for one of our clients to sit 100% remote. This person should have an extensive background in either facility-based nursing, clinical documentation, and/or inpatient coding and has a high level of understanding of reimbursement guidelines specifically an understanding of the MS-DRG, AP-DRG, and APR-DRG payment systems. This position is responsible for auditing inpatient medical records and generating high-quality recoverable claims for the benefit of our client and their clients. They are responsible for...

Company Description Job Description To independently and efficiently perform the responsibilities assigning accurate diagnosis and procedures codes to the patients health information records for: Emergency Department (ED), Ambulatory Surgical Center (ASC), Hospital Ambulatory Surgical Center (HAS), Observations (OBS), Inpatient (IP) and other selected facility records. Maintain an acceptable level of performance in quality and productivity for ICD-10-CM, ICD-10-PCS, and HCPCS/CPT classification and nomenclature systems. All work will be carried out in accordance with the: International Classification of Diseases - Official Coding Guidelines for coding and reporting as established by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS); American Medical Association (CPT); National Correct Coding Initiative (NCCI); Uniform Hospital Discharge Data Set (UHDDS), Medicaid (OMAP), and Kaiser Permanente organization/institutional...

Inpatient Facility Medical Coder (40h Day) Remote Clackamas, OR Candidates must reside either in Washington or Oregon to be considered for this position. To independently and efficiently perform the responsibilities assigning accurate diagnosis and procedures codes to the patients health information records for: Emergency Department (ED), Ambulatory Surgical Center (ASC), Hospital Ambulatory Surgical Center (HAS), Observations (OBS), Inpatient (IP) and other selected facility records. Maintain an acceptable level of performance in quality and productivity for ICD-10-CM, ICD-10-PCS, and HCPCS/CPT classification and nomenclature systems. All work will be carried out in accordance with the: International Classification of Diseases - Official Coding Guidelines for coding and reporting as established by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS); American Medical Association (CPT); National Correct Coding...

Firsthealth Of The Carolinas FirstHealth of the Carolinas is a nationally recognized health care system located in central North Carolina. Comprised of four hospitals with more than 600 beds, the system also offers leading-edge heart care in the Reid Heart Center, the area's only dedicated heart and vascular center. Our growing health system has more than 6,200 employees serving in more than 75 locations throughout a 15-county service area. In addition, FirstHealth has received numerous accolades for its patient care and outcomes, including recognitions from Healthgrades, U.S. News & World Report, and Becker's Healthcare. At FirstHealth of the Carolinas, we believe in supporting our employees' professional growth and personal well-being. That is why we offer a comprehensive benefit package that is designed to help you thrive. Enjoy a free gym-membership to one of our 7 FirstHealth Fitness Centers to stay active and prioritize your health, take advantage of our educational...

DHR Health - US:TX:McAllen - Days Summary: POSITION SUMMARY: The Inpatient coder reviews and analyzes documentation in the medical record for inpatient visits to ensure accuracy of diagnosis and procedure codes. Coder finalizes the coding and abstracting of the medical record according to ICD-10-CM/PCS, CPT, and HCPCS coding conventions and guidelines supported by the clinical documentation in the medical record. Coder analyzes diagnosis and procedure codes concurrently assigned by Clinical Documentation Specialists. The Inpatient Coder assumes primary responsibility for DRG validation/accuracy, primary role in assisting CDS and medical staff members with improving quality of clinical documentation. Sequence the diagnoses and procedures using official coding guidelines. Abstract and compile data from medical records for appropriate optimal reimbursement for hospital and/or professional charges. Resolve Inpatient billing edits. Abide by the Standards of Ethical Coding as set...

Duration: 5 months (Possible contract to hire) Work Schedule: Monday-Friday, 8am-4:30pm. Job Description: A typical day would like in this role: We are opening these positions due to increased volume of DRG review. We currently have 2 Medical Review Auditors on our team already. The normal day is DRG reviews and audits. Responsibilities: Performs validation reviews of Diagnosis Related Groups (DRG), Adaptive Predictive Coding (APC), and Never Events (inexcusable outcomes in a healthcare setting) for all lines of business. Coordinates rate adjustments with claims areas. Provides monthly and quarterly reports outlining trends. Serves as a resource in resolving coding issues. Coordinates HIPAA and legal records requests for all areas of Healthcare Services and the Legal Department. Determines methodology to identify cases for validation review. Conducts validation reviews/coordinates rates adjustments with appropriate claims area. Creates monthly/quarterly reports to present to each...

Medical Records Technician (Coder) Auditor This position is in the Health Information Management (HIM) section at the Durham VA Health Care System. The Medical Record Technician (Coder) Auditor is responsible for abstracting medical record data and assigning codes using current clinical classification systems appropriate for the type of care provided. The duties of the Auditor will include, but are not limited to: Serves as expert of current coding conventions and regulations related to professional and facility coding. Performs audits of encounters to identify areas of non-compliance in coding. Provides recommendations on appropriate coding and is responsible for maintaining current knowledge of the various regulatory guidelines and requirements. Works with staff to ensure that regulations are met or areas of weakness are identified and reported to appropriate supervisor for corrective actions. Performs prospective coding audits and utilizes results to identify processing...

DRG Validator – Remote Fully Remote | Full-Time We are partnering with a nationally recognized healthcare consulting organization specializing in Health Information Management and Revenue Integrity services. With a long-standing leadership team and a strong reputation in the hospital market, this firm is expanding its DRG validation team. If you are a highly experienced inpatient coding professional who thrives on accuracy, compliance, and clinical detail — this opportunity offers stability, flexibility, and meaningful impact. The Role The DRG Validator will conduct in-depth inpatient MS-DRG and APR-DRG validation reviews, ensuring accurate coding, appropriate documentation, and compliant reimbursement. You’ll work alongside a seasoned team of HIM specialists, nurses, and physicians who are deeply rooted in coding excellence and regulatory compliance. Key Responsibilities • Perform concurrent and retrospective MS-DRG and APR-DRG validation audits • Review ICD-10-CM &...

Payment Integrity Nurse Coder RN III The Payment Integrity Nurse Coder RN III is responsible for investigating, reviewing, and providing clinical and/or coding expertise/judgement in the application of medical and reimbursement policies within the claim adjudication process through medical record review for Payment Integrity and Utilization Management projects. The position serves as a subject matter expert (SME), performing medical records reviews to include quality audits as well as validation of accuracy and completeness of all coding elements. The position is also responsible for guidance related to Payment Integrity initiatives to include concept and cost avoidance development. This position trains and mentors Payment Integrity Nurse Coder, RN staff. Acts as a Subject Matter Expert, serves as a resource and mentor for other staff. Performs Quality Audits to include validation of accuracy and completeness of ICD, Rev Code, CPT, HCPCs, APR, DRG, POA, and all relevant coding...

Company Overview Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector. Job Summary and Responsibilities Acentra Health is looking for a Medical Coder to join our growing team. Job Summary: The Medical Coder is responsible for reviewing inpatient medical record documentation to ensure the accuracy, completeness, and clinical...

Job Description Job Description At Broadway Ventures , we transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), we empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth. Built on integrity, collaboration, and excellence, we're more than a service provider—we're your trusted partner in innovation. Position Summary We are seeking an experienced Certified Coder to support medical review activities through complex coding validations and quality assurance efforts. This role requires deep expertise in Medicare coding guidelines, DRG validation, and CMS FFS RAC Program requirements. Education High School Diploma required Associate degree or higher preferred Licensure / Certifications Certification from an accredited...

Position Title: Inpatient Coder III - Per Diem Hours: Up to 30 hours per week. Assistance needed for month end, vacation coverage, etc. Flexibility with start/end time or weekend hours is available. Location: 100% remote. Requirements: Virtual orientation held on your start date (Monday, 8:30-5). Ability to conduct training during the hours of 6 AM to 6 PM (EST) M-F Job Profile Summary ​This role focuses on activities related to revenue cycle operations such as billing, collections, and payment processing. In addition, this role focuses on performing the following Health Information Management duties: Responsible for the accuracy, maintenance, security, and confidentiality of patient's health information. An organizational related support or service (administrative or clerical) role or a role that focuses on support of daily business activities (e.g., technical, clinical, non-clinical) operating in a “hands on” environment. The majority of time is spent in the...

*Job Title: DRG Certified Coder* Employment Type: Full-Time Location: Fully Remote *About the Role! * We are seeking a highly skilled and detail-oriented DRG Certified Coder to join our Health Information Management team. The ideal candidate will be responsible for accurately assigning ICD-10-CM/PCS codes, validating DRG assignments, and ensuring compliance with all federal coding guidelines and organizational standards. This role plays a critical part in optimizing reimbursement, supporting clinical documentation integrity, and maintaining accurate data for reporting and analytics. *Description* * Review inpatient medical records to accurately assign ICD-10-CM/PCS codes according to official coding guidelines. * Assign and validate MS-DRGs / APR-DRGs to ensure appropriate reimbursement. * Collaborate with Clinical Documentation Integrity (CDI) teams to clarify documentation and support accurate code assignment. * Ensure coding accuracy and compliance with CMS, AHA Coding...

*Registered Nurse Clinical Coder - DRG Audit (100% Remote)* *Position Type:* Contract *Schedule:* Full-time, Remote *Experience Level:* Intermediate (5+ years) *Pay:* $90,000 *Overview* Our client is seeking an experienced *Registered Nurse Clinical Coder* to support DRG audit activities for one of their major healthcare partners. This role focuses on reviewing inpatient medical records, validating DRG assignments, and ensuring coding accuracy from an *insurance and payerside perspective* rather than the provider side. This is an excellent opportunity for an RN with coding experience who enjoys analytical work, documentation review, and collaborating with audit teams. *Key Responsibilities* * Perform *DRG audits* on inpatient medical records to validate ICD10 coding accuracy and DRG assignment. * Review clinical documentation to ensure compliance with payer guidelines and audit standards. * Identify discrepancies, trends, and opportunities for coding improvement. *...

Overview FirstHealth of the Carolinas is a nationally recognized health care system located in central North Carolina. Comprised of four hospitals with more than 600 beds, the system also offers leading-edge heart care in the Reid Heart Center, the area's only dedicated heart and vascular center. Our growing health system has more than 6,200 employees serving in more than 75 locations throughout a 15-county service area. In addition, FirstHealth has received numerous accolades for its patient care and outcomes, including recognitions from Healthgrades, U.S. News & World Report, and Becker's Healthcare. Employee Benefits At FirstHealth of the Carolinas, we believe in supporting our employees' professional growth and personal well-being. That is why we offer a comprehensive benefit package that is designed to help you thrive. Enjoy a free gym-membership to one of our 7 FirstHealth Fitness Centers to stay active and prioritize your health, take advantage of our...

POSITION SUMMARY: Position Summary The Inpatient Senior Coder is responsible for accurate, compliant, and timely coding and abstracting of inpatient medical records, including the assignment of ICD-10-CM/PCS codes and validation of MS-DRG and APR-DRG groupings. This position ensures proper reimbursement, adherence to regulatory and coding guidelines, and supports overall clinical documentation accuracy for inpatient services. This is a remote position with onsite availability required as needed. EDUCATION: High school diploma or equivalent. CCS (Certified Coding Specialist) Required . EXPERIENCE: * Three to five years of inpatient hospital coding experience * Proficient in ICD-10-CM and ICD-10-PCS coding * In-depth knowledge of MS-DRG and APR-DRG reimbursement systems * Familiarity with coding audits and clinical documentation review * Experience with Observation or complex outpatient cases is a plus * Prior mentoring or training experience preferred...

Position Title: Inpatient Coder III - Per Diem Hours: Up to 30 hours per week. Assistance needed for month end, vacation coverage, etc. Flexibility with start/end time or weekend hours is available. Location: 100% remote. Requirements: Virtual orientation held on your start date (Monday, 8:30-5). Ability to conduct training during the hours of 6 AM to 6 PM (EST) M-F Job Profile Summary This role focuses on activities related to revenue cycle operations such as billing, collections, and payment processing. In addition, this role focuses on performing the following Health Information Management duties: Responsible for the accuracy, maintenance, security, and confidentiality of patient's health information. An organizational related support or service (administrative or clerical) role or a role that focuses on support of daily business activities (e.g., technical, clinical, non-clinical) operating in a "hands on" environment. The majority of time is spent in the...

Location: Miramar, Florida At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience. Summary: Utilizing an electronic medical record and computerized encoder, assigns and sequences diagnosis and procedure codes and present on admission indicators for inpatient encounters based on medical record documentation in accordance with Official Coding Guidelines, CMS regulations, encoder software guidance and Health Information Management (HIM) policies and procedures. Responsibilities: Maintains strict adherence to patient confidentiality according to MHS Standards and regulatory requirements. Formulates physician queries for validation of pathological findings. Requests clinical validation queries for Clinical Documentation Integrity (CDI) review and follow-up. Seeks...

POSITION SUMMARY: Position Summary The Inpatient Senior Coder is responsible for accurate, compliant, and timely coding and abstracting of inpatient medical records, including the assignment of ICD-10-CM/PCS codes and validation of MS-DRG and APR-DRG groupings. This position ensures proper reimbursement, adherence to regulatory and coding guidelines, and supports overall clinical documentation accuracy for inpatient services. This is a remote position with onsite availability required as needed. EDUCATION: High school diploma or equivalent. CCS (Certified Coding Specialist) Required . EXPERIENCE: • Three to five years of inpatient hospital coding experience • Proficient in ICD-10-CM and ICD-10-PCS coding • In-depth knowledge of MS-DRG and APR-DRG reimbursement systems • Familiarity with coding audits and clinical documentation review • Experience with Observation or complex outpatient cases is a plus • Prior mentoring or training experience preferred...

Job Title : Inpatient Facility Medical Coder Location : Clackamas, OR, US Pay Rate : USD $27.26 - $39.37 / hr +Benefits JOB DESCRIPTION : Essential Responsibilities: Proficient in medical record review and translating clinical information into coded data. Identify and assign appropriate codes for diagnoses, procedures and other services rendered, while also validating any Computer Assisted Coded (CAC) assignments for dual coding. Utilizing the Code Base Charge Trigger system (CBCT) and OPTUM 360 EncoderPRO software system for professional surgical services, analyzing and maintaining systems accuracy, validity and meaningfulness for both professional and facility services. Utilizes electronic patient data system and clinical information system (EpicCare) to access patient encounter information. Abstracts and enters clinical data elements as defined by the needs of the organization. Identifies and assigns principal diagnosis and procedure codes, sequencing them as...