58 drg coding auditor principal jobs found

Location: This role enables associates to work virtually full-time, except for 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 accommodation is granted as required by law. 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...

Location: This role enables associates to work virtually full-time, except for 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 accommodation is granted as required by law. 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...

Location: This role enables associates to work virtually full-time, except for 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 accommodation is granted as required by law. 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...

Location: This role enables associates to work virtually full-time, except for 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 accommodation is granted as required by law. 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...

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,...

Elevance Health is seeking a Principal Patient Safety DRG Coding Auditor to audit inpatient records and drive complex DRG-based recoveries. The role requires advanced ICD-10/DRG expertise, independent work style, and collaboration with management to enhance audit criteria. Hybrid work arrangement with in-person onboarding and occasional office presence. 15+ years in related auditing and relevant certifications are preferred, with a strong track record in complex coding scenarios. #J-18808-Ljbffr

Location: This role enables associates to work virtually full-time, except for 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 accommodation is granted as required by law. Patient Safety 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...

Hospital Auditor The Hospital Auditor is responsible for reviewing hospital (inpatient and outpatient) to ensure accuracy, completeness, and compliance with regulatory guidelines and coding standards. This role supports the team's broader mission by identifying documentation gaps, validating coding accuracy, and assessing the effectiveness of hospital practices. Through targeted feedback and education, the Hospital Auditor helps strengthen documentation quality, promote compliant billing, and safeguard reimbursement integrity, ultimately contributing to improved patient care and organizational compliance. Responsibilities Conducts comprehensive record reviews to identify documentation gaps and best-practice process improvement opportunities. Performs high-level secondary case reviews to ensure accurate, complete, and compliant provider documentation. Assesses documentation alignment with ICD-10-CM/PCS, MS-DRG/APR-DRG, and payer guidelines, identifying missed or...

Coding Auditor, Facility Onsite Clackamas, OR 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 Healthcare...

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...

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...

Job Title: Medical Clinic Biller/Coder Location: Northwest Florida Community Hospital – Chipley, FL Position Type: Full-Time Position Summary: Northwest Florida Community Hospital is seeking a detail-oriented and experienced Medical Clinic Biller/Coder to join our team. This position is responsible for accurate coding, billing, and claims processing for clinic services to ensure timely reimbursement and compliance with federal regulations and payer requirements. The ideal candidate will have strong knowledge of medical terminology, coding systems, and insurance billing procedures. Responsible for all activities in the Clinic accounts receivable function. Manages billing and collection activities such as sending follow-up inquiries, negotiating with past due accounts, and referring accounts to collection agencies. Codes and sequences all diagnoses and procedures using established ICD-10-CM coding rules for each patient encounter; coding will be subject to accuracy and...

Coder Reimbursement Specialist - Hospital The Coding and Reimbursement Specialist, CCS is responsible for coding and abstracting thoroughly, clinical data from the medical record. This includes both inpatient, outpatient, commercial, Medicare, Medicaid, and Illinois Public Aid, plus any other payor types. This accurate and timely coding is essential for reimbursement to the hospital, according to the appropriately selected principal diagnosis, grouped to the DRG in accordance with rules and regulations and coding methodologies, resulting in reimbursement and billing compliances as set forth by the Office of Inspector General. Manages workload and assigns work to three inpatient and two outpatient coders and oversees the day to day workings of the coding/reimbursement area. Monitors various regulatory sources to keep HIM coding and other staff informed and trained on various coding rules, regulations and related issues. Works closely with patient financial services to resolve any...

Job Description Validates Acute Inpatient coded charts to ensure the diagnostic information leading to the assignment can be substantiated by the documentation in the Medical Record. Seeking RN candidates with a HCS-D - Home Care Coding Specialist-Diagnosis, COS-C Certificate for OASIS Specialist-Clinical. Remote position in New York. Job Responsibility 1.Leverages clinical expertise to identify and validate DRG code assignment. 2.Full review of CDI suggested code changes 3.Demonstrates comprehensive knowledge of coding guidelines and principals; performs coding audits for optimization. 4.Audits and reviews Medicare/non-Medicare charts to ensure that proper standards are maintained in compliance with Federal and State regulations. 5.Applies coding rules and regulations to the validation review process. 6.Reviews codes on Medicare/non-Medicare charts for compliance to rules and conventions. 7.Communicates DRG changes and rationale to the coding and CDI staff....

Medical Clinic Biller/Coder Northwest Florida Community Hospital is seeking a detail-oriented and experienced Medical Clinic Biller/Coder to join our team. This position is responsible for accurate coding, billing, and claims processing for clinic services to ensure timely reimbursement and compliance with federal regulations and payer requirements. The ideal candidate will have strong knowledge of medical terminology, coding systems, and insurance billing procedures. Responsible for all activities in the Clinic accounts receivable function. Manages billing and collection activities such as sending follow-up inquiries, negotiating with past due accounts, and referring accounts to collection agencies. Codes and sequences all diagnoses and procedures using established ICD-10-CM coding rules for each patient encounter; coding will be subject to accuracy and productivity rates as determined by department manager. Maintains accurate records. Audits methods and procedures of accounts...

Newport News, Virginia Hiring Range $27.30 - $37.58/HourlyActual pay is determined based on job-related factors such as relevant experience, education, credentials, skills, internal equity, and business needs. FOR APPLICATION REVIEW - PROVIDE YOUR CODER CERTIFICATION NUMBER ON YOUR APPLICATION OR RESUME This position is remote work eligible for candidates residing in the following states: FL, GA, ID, KS, KY, MS, NC, OK, SC, SD, TN, VA. Overview The Inpatient Coder II is responsible for analyzing the medical record to assign International Classification of Diseases (ICD) Clinical Modification (CM) diagnoses and Procedure Coding System (PCS) procedure codes to ensure correct code assignment and optimal reimbursement in compliance with state and federal guidelines. Works in collaboration with the Clinical Documentation Improvement (CDI) team to ensure accurate Diagnosis Related Group (DRG) assignment and works closely with management to resolve problems and meet...

Job Requirements Accurately audits hospital Inpatient, Ambulatory Surgery, Observation, and any other outpatient encounter visit for the purpose of appropriate reimbursement, research and compliance with federal and state regulations according to established ICD-10-CM/PCS coding and/or CPT-4 procedure coding classification systems. Accurately audits hospital Inpatient, Ambulatory Surgery, Observation, and any other outpatient encounter visit for the purpose of appropriate reimbursement, research and compliance with federal and state regulations according to established ICD-10-CM/PCS coding and/or CPT-4 procedure coding classification systems. Principal Responsibilities And Tasks The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all job duties performed by personnel so classified. Serves as a clinical coding subject matter expert,...

Job Title Validates Acute Inpatient coded charts to ensure the diagnostic information leading to the assignment can be substantiated by the documentation in the Medical Record. Seeking RN candidates with a HCS-D - Home Care Coding Specialist-Diagnosis, COS-C Certificate for OASIS Specialist-Clinical. Remote position in New York. Job Responsibility 1. Leverages clinical expertise to identify and validate DRG code assignment. 2. Full review of CDI suggested code changes. 3. Demonstrates comprehensive knowledge of coding guidelines and principals; performs coding audits for optimization. 4. Audits and reviews Medicare/non-Medicare charts to ensure that proper standards are maintained in compliance with Federal and State regulations. 5. Applies coding rules and regulations to the validation review process. 6. Reviews codes on Medicare/non-Medicare charts for compliance to rules and conventions. 7. Communicates DRG changes and rationale to the coding and CDI staff. 8....

Inpatient Coder II Newport News, Virginia Hiring Range: $27.30 - $37.58/Hourly. Actual pay is determined based on job-related factors such as relevant experience, education, credentials, skills, internal equity, and business needs. This position is remote work eligible for candidates residing in the following states: FL, GA, ID, KS, KY, MS, NC, OK, SC, SD, TN, VA. Overview: The Inpatient Coder II is responsible for analyzing the medical record to assign International Classification of Diseases (ICD) Clinical Modification (CM) diagnoses and Procedure Coding System (PCS) procedure codes to ensure correct code assignment and optimal reimbursement in compliance with state and federal guidelines. Works in collaboration with the Clinical Documentation Improvement (CDI) team to ensure accurate Diagnosis Related Group (DRG) assignment and works closely with management to resolve problems and meet deadlines. What You Will Do: Assigns International Classification of Diseases...

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: Responsible for auditing coded inpatient or outpatient medical records applying ICD-10 CM/PCS and/or CPT-4. Reviews Ambulatory Payment Classification (APC), Medicare Severity Diagnosis Related Groups (MSDRG) and All Patients Refined Diagnosis Related Groups (APRDRG) assignment and queries following official coding guidelines and regulatory requirements. Provides training and education based on audit results and any regulatory changes that effect Federal, State and American Health Information Management Association (AHIMA) guidelines. Responsibilities: Conducts and reports on electronic medical record audits to verify ICD-10CM/PCS, CPT and APC, MSDRG, and APRDRG coding and...

Job Title Validates Acute Inpatient coded charts to ensure the diagnostic information leading to the assignment can be substantiated by the documentation in the Medical Record. Job Responsibilities Leverages clinical expertise to identify and validate DRG code assignment. Full review of CDI suggested code changes. Demonstrates comprehensive knowledge of coding guidelines and principals; performs coding audits for optimization. Audits and reviews Medicare/non-Medicare charts to ensure that proper standards are maintained in compliance with Federal and State regulations. Applies coding rules and regulations to the validation review process. Reviews codes on Medicare/non-Medicare charts for compliance to rules and conventions. Communicates DRG changes and rationale to the coding and CDI staff. Identifies appropriate coding changes necessary to provide the most valid documentation in compliance with Federal and State regulations. Operates under general guidance...

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...

Certified Inpatient/Outpatient Medical Coder - Remote Jamison Professional Services, Inc. ("Jamison") is currently seeking a qualified and motivated candidate for the position of Certified Inpatient/Outpatient Medical Coder (Medical Records Technician). Candidates must hold at least one current certification from AHIMA or AAPC, including: Registered Health Information Technician - RHIT Certified Coding Specialist - CCS Certified Coding SpecialistPhysician Based - CCS-P Registered Health Information Administrator - RHIA Certified Professional Coder - CPC Candidates must provide documentation verifying their current certification. The Medical Records Technicians - Inpatient/Outpatient Coders will provide remote medical coding services in support of a federal healthcare client. The selected candidates will perform inpatient and outpatient medical records coding, coding validation, documentation review, provider queries, and related health information management functions....