• Inpatient DRG Reviewer

    Zelis (St. Petersburg, FL)
    …personal interests that shape who you are. Position Overview The Inpatient DRG Reviewer will be primarily responsible for conducting post-service, pre-payment ... and post pay comprehensive inpatient DRG reviews based on industry standard inpatient coding guidelines...Clinic and client specific coverage policies. Conduct prompt claim review to support internal inventory management to achieve greatest… more
    Zelis (09/02/25)
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  • DRG Specialist

    UPMC (Pittsburgh, PA)
    …compliance with coding guidelines, third-party payer and OIG regulations. **Responsibilities:** + Review and evaluate focused UPMC DRG medical records for ... UPMC Corporate Revenue Cycle is hiring a DRG Specialist to work on inpatient auditing within...years of coding experience. In this role, you will review clinical documentation within the medical record to ensure… more
    UPMC (09/10/25)
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  • DRG Specialist II

    UPMC (Pittsburgh, PA)
    …during daylight hours. The position will be fully remote! In this role, the DRG Specialist II will review clinical documentation within the medical record to ... and procedures that were performed during an episode of care. + Review and evaluate focused UPMC DRG medical records for accurate DRG assignment to ensure… more
    UPMC (08/21/25)
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  • Inpatient DRG Coding Auditor

    Emory Healthcare/Emory University (Atlanta, GA)
    …to educate physicians, nursing, and other clinical staff to improve documentation. + Review ?s DRG Reassignment letters and assists in formulating Appeal letters ... leadership programs and more! **Description** We are seeking an experienced **Inpatient DRG Coding Auditor** to extract data from patient encounters ensuring the… more
    Emory Healthcare/Emory University (09/05/25)
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  • Clinical Reimbursement Manager; HSO Drg

    Mount Sinai Health System (New York, NY)
    …of the DRG assignments flagged pre-billing. Determines if a secondary review is required to verify assignment of Patient Safety Indicators, HAC, Clinical ... **Job Description** The purpose of DRG validation is to confirm that diagnostic, procedural...Improvement,Sepsis and any other charts meeting criteria for secondary review . Initiates an MD query to clarify documentation in… more
    Mount Sinai Health System (07/17/25)
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  • DRG Auditor - October Class

    Insight Global (South Jordan, UT)
    Job Description 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 ... 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… more
    Insight Global (09/09/25)
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  • Facility Coding Inpatient DRG Quality

    Banner Health (AR)
    …quality in the Inpatient Facility Coding department. If you have experience with DRG and PCS coding/denials/audits, we want to hear from you. **Requirements:** + **5 ... facility-based medical coding (clearly reflected in your attached resume);** + ** DRG and PCS Coding, Auditing experience;** + **Bachelors degree or equivalent;**… more
    Banner Health (09/06/25)
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  • DRG Coding Auditor

    Elevance Health (Richmond, VA)
    …clinical reviews of medical records and other documentation to evaluate issues of coding and DRG assignment accuracy. Specializes in review of DRG coding via ... ** DRG CODING AUDITOR** **_Virtual_** **_: _** _ _...to recover, eliminate and prevent unnecessary medical-expense spending. The ** DRG CODING AUDITOR** is responsible for auditing inpatient medical… more
    Elevance Health (08/13/25)
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  • Diagnosis Related Group Clinical Validation…

    Elevance Health (Hanover, MD)
    …clinical documentation supports the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group ( DRG ) paid claims. **How you will ... **Diagnosis Related Group Clinical Validation Auditor-RN (CDI, MS- DRG , AP- DRG and APR- DRG )** **Virtual:** This role enables associates to work virtually… more
    Elevance Health (08/23/25)
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  • Director Clinical and DRG Denials

    Kaleida Health (Buffalo, NY)
    …and insurance / managed care practices including but not limited to: utilization review , RAC, MAC, Q10, clinical and DRG denial management required. **Working ... **Director Clinical and DRG Denials** **Location:** Larkin Bldg @ Exchange Street...Shift 1 Job Description **Summary:** The Director, Clinical & DRG Denials provides clinical leadership and administrative guidance to… more
    Kaleida Health (06/19/25)
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