629 drg coding auditor jobs found

DRG Coding Auditor - MS-DRG and APR-DRG Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development . Alternate locations may be considered if candidates reside within a commuting distance from an office Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The DRG Coding Auditor is responsible for auditing inpatient medical records and generating high quality recoverable claims for the benefit of the company, for all lines of business, and its clients. Also responsible for performing clinical reviews of medical records and other documentation to...

Registered Nurse - Diagnosis Related Group Coding Auditor Principal – Carelon Payment Integrity Location: Alternate locations may be considered. This position will work in a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations. Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate, and prevent unnecessary medical-expense spending. The DRG Coding Auditor Principal is responsible for auditing inpatient medical records on claims paid based on Diagnostic Relation Group (DRG) methodology, including case rate and per diem, generating highly complex audit findings recoverable claims for the benefit of the Company, for all lines of business, and its clients. Specializes in review of DRG coding via medical records and attending physician’s statements provided by acute care hospitals on paid DRG,...

DRG Coding Auditor - MS-DRG and APR-DRG Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development . Alternate locations may be considered if candidates reside within a commuting distance from an office Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The DRG Coding Auditor is responsible for auditing inpatient medical records and generating high quality recoverable claims for the benefit of the company, for all lines of business, and its clients. Also responsible for performing clinical reviews of medical records and other documentation to...

Overview Be inspired. Be valued. Belong. At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoing mentorship and leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be. We provide: Comprehensive health benefits that start day 1 Student Loan Repayment Assistance & Reimbursement Programs Family-focused benefits Wellness incentives Ongoing mentorship, development, leadership programs...and more! Description We are seeking an experienced Inpatient DRG Coding Auditor to extract data from patient encounters ensuring the accuracy of DRGs. This individual will: Reviews inpatient medical records for select payer populations post-discharge and pre-bill; audits the accuracy and completeness of diagnosis and procedure coding, DRG assignment, and abstracted data POA, Discharge Disposition. Reviews discrepancies between the Clinical...

Overview Be inspired. Be valued. Belong. At Emory Healthcare At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoingmentorshipand leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be.We provide: Comprehensive health benefits that start day 1 Student Loan Repayment Assistance & Reimbursement Programs Family-focused benefits Wellness incentives Ongoing mentorship, development, leadership programs And more Description JOB DESCRIPTION: Reviews inpatient medical records for select payer populations post-discharge and pre-bill; audits the accuracy and completeness of diagnosis and procedure coding, DRG assignment, and abstracted data POA, Discharge Disposition. Reviews discrepancies between the Clinical Documentation Specialist (CDS) DRG and the Coder DRG. Reviews non-CC/MCC records to determine if record...

Job Title Be inspired. Be valued. Belong. At Emory Healthcare Job Description Reviews inpatient medical records for select payer populations post-discharge and pre-bill; audits the accuracy and completeness of diagnosis and procedure coding, DRG assignment, and abstracted data POA, Discharge Disposition. Reviews discrepancies between the Clinical Documentation Specialist (CDS) DRG and the Coder DRG. Reviews non-CC/MCC records to determine if record was miscoded or if additional documentation is needed. Works with Coders and CDSs to draft and initiate physician queries. Performs reviews in a timely manner to maintain DNFB target of 4 days. Provides Coding development with coordination of educational and training programs regarding technical coding and clinical topics for the coding staff. Coordinates remediation when required. Coordinates with the Coding leadership, Quality nurses and the CDS team to educate physicians, nursing, and other clinical staff to improve...

This position audits the accuracy and completeness of diagnosis and procedure coding, DRG assignment, and abstracted data to support that appropriate reimbursement and clinical severity is captured for the level of service rendered. Provides ongoing education to coders, physicians, and other clinical staff. The incumbent serves in an advisory and educator role for coding and regulatory compliance. Responsibilities Essential Functions Reviews inpatient medical records post-discharge and pre-bill, audits the accuracy and completeness of diagnoses, procedure coding, abstracted data and DRG assignment. Reviews non-CC/MCC records to determine if the record was coded correctly or if additional codes may be reported by obtaining documentation supported by clinical indicators and treatment. Develops and coordinates coding education and formal training programs. Improves documentation by participating in the CDI query audit process. Works effectively with the Coding Manager to improve...

Overview Be inspired. Be valued. Belong. At Emory Healthcare At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoingmentorshipand leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be.We provide: Comprehensive health benefits that start day 1 Student Loan Repayment Assistance & Reimbursement Programs Family-focused benefits Wellness incentives Ongoing mentorship, development, leadership programs And more Description JOB DESCRIPTION: Reviews inpatient medical records for select payer populations post-discharge and pre-bill; audits the accuracy and completeness of diagnosis and procedure coding, DRG assignment, and abstracted data POA, Discharge Disposition. Reviews discrepancies between the Clinical Documentation Specialist (CDS) DRG and the Coder DRG. Reviews non-CC/MCC records to determine if record was miscoded or if...

Stryker Corporation in Salt Lake City is seeking a qualified HIM professional to audit diagnosis and procedure coding, DRG assignment, and abstracted data to ensure accurate reimbursement and clinical severity. Responsibilities include reviewing inpatient records post-discharge, auditing coding accuracy, developing training programs, and collaborating with the Coding Manager to improve inpatient coding. The role emphasizes education of coders, physicians, and staff and requires CCS certification #J-18808-Ljbffr

AHIMA is seeking a senior role responsible for auditing diagnosis and procedure coding, DRG assignment, and data abstraction to ensure proper reimbursement and clinical severity capture for services rendered. The incumbent educates coders, physicians, and clinical staff, serving in an advisory role for coding and regulatory compliance. This position partners with the Coding Manager to improve inpatient coding accuracy and documentation quality. #J-18808-Ljbffr

RCM Healthcare Services is seeking a DRG Coding Reviewer to support inpatient coding validation and payment integrity initiatives. This remote, full-time role offers a salary of $85,000 to $95,000 plus competitive benefits, 401(k) match, and PTO. You will review inpatient claims to validate ICD-10 coding and DRG assignments, perform coding and clinical validation reviews, and collaborate with physician reviewers. #J-18808-Ljbffr

Ensemble Health Partners seeks an Inpatient/DRG Validation Coding Auditor to review medical records and ensure accurate DRG assignment and documentation. You will identify discrepancies, educate coders, and help improve reimbursement accuracy for hospital clients. The role requires 5+ years of coding and 3+ years of facility audit experience, proficiency with EMR systems and encoders, and maintaining HIPAA compliance. #J-18808-Ljbffr

Humana, a Fortune 100 Company, is seeking an experienced and Certified Inpatient Medical Coding Auditor to review hospital claims for proper reimbursement and resolve provider disputes. You will extract clinical information from medical records, assign ICD-10-CM/PCS and DRG codes, audit coding quality, and collaborate with teams to improve payment accuracy and reduce errors. This remote position offers a competitive bonus plan and comprehensive benefits. #J-18808-Ljbffr

A leading health insurance provider based in Olympia, WA, is seeking an Inpatient Medical Coding Auditor. The role involves reviewing inpatient hospital claims for proper reimbursement and requires strong qualifications, including RHIA, RHIT, or CCS certification with MS-DRG experience. This remote position allows for flexible work hours and contributes significantly to cost reduction and accuracy in provider payments. Join a company committed to the well-being of its clients and team members. #J-18808-Ljbffr

Humana Inc. is looking for an experienced Certified Inpatient Medical Coding Auditor to review inpatient hospital claims for proper reimbursement and resolve provider disputes. The role focuses on ICD-10-CM, ICD-10-PCS, and DRG code assignments to ensure accurate payments and cost control. Work hours are Monday–Friday, with a remote arrangement; travel to Humana offices may be required occasionally. Eligible for a bonus plan and comprehensive benefits including medical, dental, vision, and a #J-18808-Ljbffr

Spectraforce Technologies in Columbia, SC seeks a Quality Medical Auditor to perform validation reviews of DRG, APC, and Never Events across lines of business. You will coordinate rate adjustments with claims and produce monthly and quarterly reports. The role requires strong knowledge of medical record coding, HIPAA compliance, and data analysis. This contract is 4 months with possible conversion, with a remote-friendly onsite-focused schedule. #J-18808-Ljbffr

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

Prime Healthcare is seeking an Inpatient Coder Auditor to review medical records for accurate ICD-10-CM/PCS, CPT, and HCPCS coding. You will finalize coding, support CDS and staff, and contribute to DRG validation initiatives while ensuring compliant documentation across acute care records. The role emphasizes accurate chart abstraction, collaboration with clinicians, and adherence to coding standards in a fast-paced environment. Full-time on-site in Ontario, CA. #J-18808-Ljbffr

Huron Consulting Group Inc. in Chicago is seeking an Inpatient Coding Auditor to review inpatient coders and offshore auditors, ensuring DRG accuracy of at least 95% and coding quality. You will communicate findings via phone, email, and instant messaging with client teams and payers, and report to the Huron Managed Services Domestic Coding team. Responsibilities include audits, quality checks, calibration sessions, and preparing reports with clear, actionable feedback. #J-18808-Ljbffr

Baptist Health Care is seeking a Coding Auditor to review and audit patient records for correct ICD-10-CM/PCS codes, CPT codes, POA assignment and MS-DRG assignment. The role will issue quarterly report cards and provide coding training and education to coders. The ideal candidate has at least five years of inpatient and/or outpatient coding experience and holds CCS, CPC, and CCA certifications. Knowledge of Medicare and other third-party payer regulations is required. #J-18808-Ljbffr

EnableComp is seeking a DRG Auditor to review post-billed inpatient claims, validate missed reimbursement opportunities, and optimize hospital reimbursement using ICD-10 coding and DRG guidelines. You will analyze records in a specialized DRG database, identify coding errors, and recommend improvements while maintaining PHI privacy and security. This role supports nationwide hospital systems. #J-18808-Ljbffr

Humana Inc. is seeking a Certified Inpatient Medical Coding Auditor to review inpatient hospital claims for proper reimbursement and resolve provider disputes. The role extracts clinical information from medical records and assigns ICD-10-CM, ICD-10-PCS codes and DRG classifications to patient records. The goal is to ensure accuracy and integrity of hospital claim payments. You will review complex documentation, identify opportunities for improvement, and collaborate with cross-functional teams #J-18808-Ljbffr

EnableComp is seeking a DRG Auditor to review post-billed inpatient claims, validate missed reimbursement opportunities, and optimize hospital reimbursement using ICD-10 coding and DRG guidelines. You will analyze records in a specialized DRG database, identify coding errors, and recommend improvements while maintaining PHI privacy and security. This role supports nationwide hospital systems. #J-18808-Ljbffr

Humana Inc. is seeking an experienced Certified Inpatient Medical Coding Auditor to review inpatient claims for proper reimbursement and resolve provider disputes. You will extract clinical information and assign ICD-10-CM, ICD-10-PCS, and DRG codes to patient records, ensuring coding accuracy and payment integrity. The role targets cost reduction by improving payment accuracy, with responsibilities spanning audits, data analysis, and cross-team collaboration. #J-18808-Ljbffr