• Manager, DRG Coding & Validation (RN)…

    Molina Healthcare (Columbus, OH)
    **Job Description** **Job Summary** The Manager, Clinical DRG Coding & Validation must have an extensive background in either facility-based nursing and/or inpatient ... a high level of understanding in reimbursement guidelines specifically related to MS- DRG , AP- DRG and APR- DRG payment systems. Key participant in the… more
    Molina Healthcare (06/14/25)
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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 ... OIG regulations. **Responsibilities:** + Review and evaluate focused UPMC DRG medical records for accurate DRG assignment...focused UPMC DRG medical records for accurate DRG assignment to ensure that all documented principal and… more
    UPMC (06/11/25)
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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 (06/06/25)
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  • DRG Coding Auditor Principal

    Elevance Health (Norfolk, VA)
    ** DRG Coding Auditor Principal** _Virtual: This role enables associates to work virtually full-time, providing maximum flexibility and autonomy. This approach ... onboarding and skill development. Alternate locations may be considered._ The DRG Coding Auditor Principal is responsible for auditing inpatient medical records… more
    Elevance Health (06/05/25)
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  • DRG Coding Auditor

    Elevance Health (Chicago, IL)
    ** DRG CODING AUDITOR** **Location** : _This position will work virtually._ _Alternate locations may be considered._ The ** DRG CODING AUDITOR** is responsible for ... and other documentation to evaluate issues of coding and DRG assignment accuracy. Specializes in review of DRG... DRG assignment accuracy. Specializes in review of DRG coding via medical record and attending physician's statement… more
    Elevance Health (06/24/25)
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  • Facility Coding Inpatient DRG Quality

    Banner Health (OH)
    …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 (06/15/25)
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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 (06/19/25)
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  • Inpatient DRG Quality Auditor

    Humana (Santa Fe, NM)
    …Management organization, including offshore and vendor partners, with a focus on DRG audits. You will also drive process improvement initiatives and develop ... Management organization, including offshore and vendor partners, with a focus on DRG audits. You will also drive process improvement initiatives and develop… more
    Humana (06/17/25)
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  • Medical Director DRG (Medical Policy…

    CVS Health (Hartford, CT)
    …Commercial and Medicare environment. In addition, be a subject matter expert in DRG reviews and ICD-10 code selection. This Medical Director provides subject matter ... / CPT, Clinical Policy, Reimbursement and Health Care Systems. * Experience with DRG reviews. * Strong communication skills both written and verbal. **Education** *… more
    CVS Health (06/23/25)
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  • Coding Appeals Specialist

    St. Luke's University Health Network (Allentown, PA)
    …data and coding of all diagnosis and procedure codes to assure properly assigned MS- DRG for the purposes of appealing proposed MS- DRG and coding changes by ... record reviews for diagnosis and procedure code assignment and MS- DRG accuracy for inpatient encounters and CPT assignment for...inpatient encounters and CPT assignment for OP encounters. Analyze DRG or CPT denial letters and draft appeal letters,… more
    St. Luke's University Health Network (05/19/25)
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