9 drg validation coding auditor jobs found

To ensure coding accuracy and clinical chart validation for inpatient audits, the full-time Clinical Coding Auditor will analyze claims, utilize proprietary audit tools, and maintain productivity and quality standards while working remotely. Key responsibilities Analyzes and audits inpatient claims using advanced ICD-10 coding expertise and clinical guidelines Effectively utilizes proprietary auditing systems to make determinations and generate audit documentation Meets or exceeds established standards for productivity, accuracy, and quality in auditing processes Required qualifications Associate or bachelor's degree in nursing or Health Information Management (RHIA or RHIT) or equivalent experience in claims auditing Active coding/CDI certification (e.g., RHIA, RHIT, CPC, CCS, CIC, CDIP, or CCDS) 5 to 7+ years of experience with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG in claims auditing Expert knowledge of coding guidelines, medical necessity criteria, and payer reimbursement...

Focused on Coding & Clinical Chart Validation, the full-time Certified Coding Auditor will conduct audits of outpatient and specialty claims, ensuring coding accuracy and compliance with medical necessity and treatment appropriateness. Key responsibilities Audits outpatient and specialty claims using medical chart coding principles and client-specific guidelines Utilizes advanced audit tools and maintains productivity and quality standards in auditing processes Identifies new claim types and recommends improvements to enhance audit production and client satisfaction Required qualifications Associate or bachelor's degree in Health Information Management (RHIA or RHIT) or equivalent experience Coding certification (e.g., CPC, CIC, CCS, CCS-P, RHIA, or RHIT) required and maintained 5 to 7 years of experience in clinical medical record coding or auditing, with knowledge of HIPAA and CMS requirements Expert knowledge of coding guidelines, including DRG, ICD-10, CPT, and HCPCS...

We’re Hiring: Nurse DRG Auditors (Payment Integrity) + Inpatient & RN Coders | Remote We’re growing and looking for detail-driven, high-impact healthcare professionals to join our team! If you’re passionate about coding accuracy, DRG validation, and revenue integrity, this is your opportunity to work with a collaborative, forward-thinking organization. Featured Role: Nurse DRG Auditor – Payment Integrity Salary: $95,000 – $105,000 Location: Remote What You’ll Do: Perform DRG validation and quality audits to ensure coding accuracy and appropriate reimbursement Analyze clinical documentation and coding for payment integrity opportunities Apply Medicare/CMS guidelines to validate claims and identify discrepancies Partner with coding, CDI, and compliance teams to drive accuracy and outcomes What You Bring: RN Required National Coding Certification (CIC, CCS, etc.) 2+ years of recent DRG Quality Auditing experience (hospital or health plan) Strong expertise in ICD-10-CM/PCS Deep...

At TREND Health Partners, a tech-enabled payment integrity company, our mission is to facilitate collaboration between payers and providers for mutual benefit and waste reduction, ultimately improving access to healthcare. We achieve this by aligning the common goals of payers and providers and fostering collaboration through a shared technology platform and seamless workflows. Joining TREND Health Partners means becoming a part of a dynamic growing organization that promotes a collaborative and innovative work environment. Our comprehensive compensation package includes competitive salaries, highly valued health insurance, a 401(k) plan with employer match, paid parental leave, and more. The Outpatient Coding Auditor’s responsibility is to review medical records, clinical documentation, and claims to ensure accurate ICD-10, CPT, and HCPCs coding and compliance with CMS and coding guidelines. The role will be to apply coding principles based on industry standards and...

TREND Health Partners is a tech-enabled payment integrity company. Our mission is to facilitate collaboration between payers and providers for mutual benefit and waste reduction, ultimately improving access to healthcare. We achieve this by aligning the common goals of payers and providers and fostering collaboration through a shared technology platform and seamless workflows. Joining TREND Health Partners means becoming part of a dynamic, growing organization that promotes a collaborative and innovative work environment. Our comprehensive compensation package includes competitive salaries, highly valued health insurance, a 401(k) plan with employer match, paid parental leave, and more. The Nurse Coder DRG Auditor’s primary responsibility is to review medical records and associated claim information to validate accuracy of DRG assignments and/or medical necessity for inpatient level of care. This role will apply coding and clinical principles based on industry standards and...

A leading healthcare intelligence company is seeking a DRG Reviewer to conduct thorough audits of medical records for payment validation. This role requires expertise in coding, clinical guidelines, and compliance with payment standards. The ideal candidate should have at least two years of inpatient auditing experience, strong analytical skills, and attention to detail. This position offers competitive compensation ranging from $90,000 to $115,000, along with additional benefits and a flexible work-from-home option. #J-18808-Ljbffr

Iberia Medical Center (IMC) in New Iberia, LA is looking for team members who will help advance our vision to be the premier hospital of choice for patients, physicians, and employees. We have proudly cared for our community for over 60 years and offer diverse career opportunities throughout our organization. Our employees experience opportunities to learn, grow, and make a meaningful impact while caring for their families, friends, and neighbors. IMC is looking to hire a DRG Coder - Remote . This employee is under the direction of the Revenue Cycle Manager, responsible for assigning ICD-10-CM and ICD-10-PCS codes to inpatient medical records upon discharge and assigning the appropriate MS-DRG for reimbursement purposes. This remote position works closely with Clinical Documentation Improvement (CDI) Specialists and serves as an active participant on the Compliant Documentation Management Program Team. The DRG Coder is responsible for ensuring accurate, compliant, and timely...

A healthcare technology firm is seeking a Nurse Coder DRG Auditor to validate coding accuracy and medical necessity of inpatient claims. The role involves applying industry standards and guidelines to perform DRG validations while collaborating within a team. Successful candidates will have an active RN license, relevant coding certifications, and experience in clinical practice. A competitive salary of $85,000 to $90,000 is offered, along with a comprehensive benefits package. #J-18808-Ljbffr

Base pay range $30.00/hr - $37.00/hr Job Title: Remote Inpatient Medical Coder & Inpatient Team Lead Location: 100% Remote (Must reside in the Central Time Zone ) Schedule: Monday – Friday | 8:00 AM – 4:30 PM CT Employment Type: Full-Time Federal Contract Duration: Long-term Role Overview We are seeking experienced Inpatient Medical Coders and a high-performing Inpatient Team Lead for a high-volume facility within the VA healthcare system. These are fully remote positions requiring a high level of investigative accuracy and a deep understanding of complex inpatient documentation. Note: Previous experience within the VA, a University Medical Center, or a Teaching Hospital is mandatory. Core Responsibilities Medical Coding: Review complex inpatient medical records to assign accurate ICD-10-CM, ICD-10-PCS, and DRGs. Data Validation: Perform 100% data validation of assigned encounters to ensure diagnostic integrity. Provider Queries: Interface with clinicians for...