• Payment Integrity DRG Coding & Clinical…

    Excellus BlueCross BlueShield (Rochester, NY)
    Job Description: Summary: The Payment Integrity DRG Coding & Clinical Validation Analyst position has an extensive background in acute facility-based clinical ... coding and has a high level of understanding of the current MS- DRG , and APR- DRG payment systems. This position is responsible for reviewing medical records for… more
    Excellus BlueCross BlueShield (10/23/25)
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  • DRG Specialist

    UPMC (Pittsburgh, PA)
    UPMC Corporate Revenue Cycle is hiring a DRG Specialist to work on inpatient auditing within our Coding Department. This position will be a work-from-home position ... an episode of care. + Review and evaluate focused UPMC DRG medical records for accurate DRG assignment to ensure that all documented principal and secondary… more
    UPMC (10/03/25)
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  • Inpatient DRG Reviewer

    Zelis (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...criteria plan, and policy exclusions. Conduct reviews on inpatient DRG claims as they compare with medical records ICD-10… more
    Zelis (09/27/25)
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  • Inpatient DRG Coding Auditor

    Emory Healthcare/Emory University (Atlanta, GA)
    …leadership programs and more! **Description** We are seeking an experienced **Inpatient DRG Coding Auditor** to extract data from patient encounters ensuring the ... 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… more
    Emory Healthcare/Emory University (09/05/25)
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  • DRG Auditor - January 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 ... of understanding of reimbursement guidelines specifically an understanding of the MS- DRG , AP- DRG , and APR- DRG payment systems. This position is responsible… more
    Insight Global (11/08/25)
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  • DRG Coding Auditor

    Elevance Health (Hanover, MD)
    ** DRG CODING AUDITOR** **_Virtual_** **_: _** _ _ _​_ This role enables associates to work virtually full-time, with the exception of required in-person training ... determined to recover, eliminate and prevent unnecessary medical-expense spending. The ** DRG CODING AUDITOR** is responsible for auditing inpatient medical records… more
    Elevance Health (10/25/25)
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  • Inpatient DRG Sr. Reviewer

    Zelis (NJ)
    …is responsible for conducting post-service, pre-payment and post pay comprehensive inpatient DRG Quality Assurance reviews in an effort to increase the savings ... achieved for Zelis clients. Conduct reviews on inpatient DRG claims as they compare with medical records utilizing ICD-10 Official Coding Guidelines, AHA Coding… more
    Zelis (10/03/25)
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  • Diagnosis Related Group Clinical Validation…

    Elevance Health (Las Vegas, NV)
    **Diagnosis Related Group Clinical Validation Auditor-RN (CDI, MS- DRG , AP- DRG and APR- DRG )** **Virtual:** This role enables associates to work virtually ... and reimbursed. Specializes in review of Diagnosis Related Group ( DRG ) paid claims. **How you will make an impact:**...minimum of 5 years of experience working with ICD-9/10CM, MS- DRG , AP- DRG and APR- DRG ; or… more
    Elevance Health (11/12/25)
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  • Director Clinical and DRG Denials

    Kaleida Health (Buffalo, NY)
    **Director Clinical and DRG Denials** **Location:** Larkin Bldg @ Exchange Street Location of Job: US:NY:Buffalo Work Type: Full-Time **Shift:** Shift 1 Job ... Description **Summary:** The Director, Clinical & DRG Denials provides clinical leadership and administrative guidance to the Clinical Revenue Cycle department.… more
    Kaleida Health (09/17/25)
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  • DRG Denials Auditor

    Community Health Systems (Franklin, TN)
    **Job Summary** The DRG Denials Auditor conducts hospital inpatient DRG denial audits for both RAC and non-RAC accounts, reviewing patient records for accuracy ... in ICD-10-CM/PCS coding, DRG assignments, and supporting clinical documentation. This includes evaluating present on admission (POA) indicators, discharge… more
    Community Health Systems (09/09/25)
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