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Contract Drg Validation Reviewer Jobs (NOW HIRING)

MedReview

DRG Reviewer

Manhattan, NY · On-site +1

$85K - $90K/yr

Analyze and review inpatient claims following the Official Coding and Reporting Guidelines to validate the reported ICD-10-CM/PCS codes to ensure proper DRG assignment for accurate billing.

MedReview

DRG Reviewer

Manhattan, NY · Remote

Analyze and review inpatient claims following the Official Coding and Reporting Guidelines to validate the reported ICD-10-CM/PCS codes to ensure proper DRG assignment for accurate billing.

Centene

DRG Reviewer

Kansas City, MO · On-site +1

$70K - $126K/yr

... contracts, and organizational policies. * Independently conducts comprehensive MS-DRG and APR-DRG coding and clinical validation reviews, exercising professional judgment to verify ICD-10-CM/PCS ...

Centene

DRG Reviewer

$70K - $126K/yr

... contracts, and organizational policies. * Independently conducts comprehensive MS-DRG and APR-DRG coding and clinical validation reviews, exercising professional judgment to verify ICD-10-CM/PCS ...

Centene

DRG Reviewer

Jefferson City, MO · On-site +1

$70K - $126K/yr

... contracts, and organizational policies. * Independently conducts comprehensive MS-DRG and APR-DRG coding and clinical validation reviews, exercising professional judgment to verify ICD-10-CM/PCS ...

Centene

DRG Reviewer

Columbia, MO · On-site +1

$70K - $126K/yr

... contracts, and organizational policies. * Independently conducts comprehensive MS-DRG and APR-DRG coding and clinical validation reviews, exercising professional judgment to verify ICD-10-CM/PCS ...

Centene

DRG Reviewer

Kansas City, MO · On-site +1

$70K - $126K/yr

... contracts, and organizational policies. * Independently conducts comprehensive MS-DRG and APR-DRG coding and clinical validation reviews, exercising professional judgment to verify ICD-10-CM/PCS ...

Centene

DRG Reviewer

Florissant, MO · On-site +1

$70K - $126K/yr

... contracts, and organizational policies. * Independently conducts comprehensive MS-DRG and APR-DRG coding and clinical validation reviews, exercising professional judgment to verify ICD-10-CM/PCS ...

MMC Group

DRG Auditor

San Antonio, TX · Remote

Review inpatient medical records to validate the admit order, assignment and sequencing of ICD9-CM ... If the contract requires onsite review, interact with Providers and other personnel in a ...

Jzanus Consulting

DRG Validator- Remote

Garden City, NY · Remote

$85K/yr

Key Responsibilities Perform concurrent and retrospective clinically based and MS-DRG and APR DRG validation reviews in compliance with appropriate coding and payments adhering to Uniform Hospital ...

EnableComp

DRG Validator/Reviewer (REMOTE)

OR · Remote

Certified Coding Specialist (CCS) certification required. * 2-3 years' experience in DRG validation, inpatient medical coding, or related coding review. * Strong understanding of ICD-10-CM/PCS coding ...

EnableComp

DRG Validator/Reviewer (REMOTE)

OR · On-site +1

Certified Coding Specialist (CCS) certification required. * 2-3 years' experience in DRG validation, inpatient medical coding, or related coding review. * Strong understanding of ICD-10-CM/PCS coding ...

EnableComp

DRG Validator/Reviewer (REMOTE)

Franklin, TN · Remote

Certified Coding Specialist (CCS) certification required. * 2-3 years' experience in DRG validation, inpatient medical coding, or related coding review. * Strong understanding of ICD-10-CM/PCS coding ...

EnableComp

DRG Validator/Reviewer (REMOTE)

Franklin, TN · Remote

Certified Coding Specialist (CCS) certification required. * 2-3 years' experience in DRG validation, inpatient medical coding, or related coding review. * Strong understanding of ICD-10-CM/PCS coding ...

EnableComp

DRG Validator/Reviewer (REMOTE)

Certified Coding Specialist (CCS) certification required. * 2-3 years' experience in DRG validation, inpatient medical coding, or related coding review. * Strong understanding of ICD-10-CM/PCS coding ...

Med Review Inc

Physician Reviewer

Manhattan, NY · On-site

Perform DRG Clinical Validation reviews to ensure diagnoses are accurate, supported, and compliant * Evaluate medical records, diagnostic findings, and treatment plans using evidence-based guidelines

Med Review Inc

Physician Reviewer

Perform DRG Clinical Validation reviews to ensure diagnoses are accurate, supported, and compliant * Evaluate medical records, diagnostic findings, and treatment plans using evidence-based guidelines

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How much do contract drg validation reviewer jobs pay per hour?

As of Aug 20, 2026, the average hourly pay for contract drg validation reviewer in the United States is $52.00, according to ZipRecruiter salary data. Most workers in this role earn between $39.42 and $63.22 per hour, depending on experience, location, and employer.

What is a Contract DRG Validation Reviewer?

Contract DRG (Diagnosis-Related Group) Validation Reviewers are healthcare professionals who review medical records and billing data to ensure that hospital claims for inpatient services are accurately coded and compliant with payer requirements. Their main focus is to verify that the assigned DRG codes match the clinical documentation and that the hospital is reimbursed correctly. These reviewers typically work on a contract basis for hospitals, insurance companies, or third-party auditing firms, and help identify and prevent errors or potential fraud in billing. Their expertise contributes to accurate healthcare payments and regulatory compliance.

What are the key skills and qualifications needed to thrive as a Contract DRG Validation Reviewer?

To thrive as a Contract DRG Validation Reviewer, you need in-depth knowledge of medical coding (especially ICD-10-CM/PCS), DRG assignment, and a background in nursing or health information management, often supported by RHIA, RHIT, or CCS certification. Familiarity with medical record review software, coding tools, and hospital information systems is typically required. Strong analytical thinking, attention to detail, and effective communication are crucial soft skills for interpreting records and liaising with healthcare providers. These skills ensure accurate DRG validation, regulatory compliance, and optimal reimbursement in healthcare organizations.

What are some common challenges faced by Contract DRG Validation Reviewers, and how can they be addressed?

Contract DRG Validation Reviewers often encounter challenges such as interpreting complex medical documentation, staying current with frequently updated coding guidelines, and ensuring accuracy under tight deadlines. Effective communication with healthcare providers and coding teams is crucial when clarifying ambiguous records. To address these challenges, many reviewers regularly participate in coding workshops, maintain up-to-date certifications, and collaborate closely with compliance and quality assurance teams to stay aligned with industry standards.

What is the difference between Contract Drg Validation Reviewer vs Contract Medical Coder?

AspectContract Drg Validation ReviewerContract Medical Coder
CredentialsTypically requires coding certifications and knowledge of DRG systemsRequires medical coding certifications (e.g., CPC, CCS)
Work EnvironmentHospitals, insurance companies, or healthcare consulting firmsHospitals, clinics, or billing companies
Industry UsageUsed for reviewing and validating DRG assignments for reimbursementUsed for assigning medical codes to diagnoses and procedures

The Contract Drg Validation Reviewer focuses on verifying DRG assignments for billing accuracy, while the Contract Medical Coder assigns specific medical codes to diagnoses and procedures. Both roles require coding certifications and work within healthcare settings, but their primary responsibilities differ in the billing validation versus coding process.

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Contract Drg Validation Reviewer jobs near you
Infographic showing various Contract Drg Validation Reviewer job openings in the United States as of August 2026, with employment types broken down into 62% Full Time, 13% Temporary, and 25% Contract. Highlights an 38% In-person, and 62% Remote job distribution, with an average salary of $108,152 per year, or $52 per hour.

DRG Reviewer

MedReview

Manhattan, NY • On-site, Remote

$85K - $90K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 15 days ago

Job description

Position Summary
At MedReview, our mission is to bring accuracy, accountability, and clinical excellence to healthcare. We are a leading authority in payment integrity solutions, including DRG Validation, Cost Outlier, and Readmission Reviews.
Under the direction of the DRG Operations leadership team, the DRG Reviewer conducts reviews of inpatient claims to ensure coding accuracy and appropriate DRG assignment while identifying cases requiring clinical review to support coded diagnoses.
This is a fully remote position. Candidates must be available to work Eastern Standard Time (EST) business hours.
Salary: $85,000-$90,000 annually, commensurate with experience.
Responsibilities:
  • Analyze and review inpatient claims following the Official Coding and Reporting Guidelines to validate the reported ICD-10-CM/PCS codes to ensure proper DRG assignment for accurate billing.
  • Demonstrates the ability to perform a comprehensive initial review as outlined in the standard operating procedures and departmental guides.
  • Collaborates with physician reviewers, as needed.
  • Ability to prioritize and organize workload and complete tasks independently.
  • Required attendance of all departmental team meetings and/or training.
  • Work on other duties or tasks, as necessary.

Performance Expectations:
  • Report productivity daily utilizing department productivity report.
  • Meet/exceed daily productivity expectations.
  • Maintains 95% accuracy in claim reviews.
  • Must be available to work a 7.5-hour workday during Eastern Standard Time (EST) business hours.
  • Comply with organization policy and procedures.

Qualifications:
  • Coding Certification required (at least one of the following is required and must be maintained as a condition of employment).
    • Certified Coding Specialist (CCS)
    • Certified Inpatient Coder (CIC)
    • Registered Heath Information Technician (RHIT)
  • College level courses in medical terminology, anatomy, pathophysiology, pharmacology, and medical coding courses.
  • At least 3 years' experience in MS-DRG and APR-DRG validation in acute care inpatient coding, auditing. Payment integrity DRG validation is a plus.
  • Adherence to the Official Coding and Reporting guidelines, AHA Coding Clinic determinations, and CMS and other regulatory compliance guidelines and mandates.
  • Requires working knowledge of applicable industry-based standards.
  • Proficiency in Outlook, Word, Excel, and other applications.
  • Excellent written and verbal communication skills.
  • Maintain professional credentialed status with approved continuing education programs
  • Ability to work independently and can multi-task or transition to different tasks easily.
Remote Work Requirements:
  • High speed internet (100 Mbps per person recommended) with secured WIFI.
  • A dedicated workspace with minimal interruptions to protect PHI and HIPAA information.
  • Must be able to sit and use a computer keyboard for extended periods of time.

Benefits and perks include:
  • Healthcare that fits your needs - We offer excellent medical, dental, and vision plan options that provide coverage to employees and dependents.
  • 401(k) with Employer Match - Join the team and we will invest in your future
  • Generous Paid Time Off - Accrued PTO starting day one, plus additional days off when you're not feeling well, to observe holidays.
  • Wellness - We care about your well-being. From Commuter Benefits to FSAs we've got you covered.
  • Learning & Development - Through continued education/mentorship on the job and our investment in LinkedIn Learning, we're focused on your growth as a working professional.

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