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Drg Analyst Jobs (NOW HIRING)

Machinify

DRG Manager

Lead the DRG team by providing guidance, counsel, and development plans to ensure long-term ... Analytical Problem-Solving: Demonstrate analytical skills to identify problems and trends, develop ...

Astrana Health, Inc.

$33 - $38/hr

Analyze denials and underpayments related to coding and DRG assignment * Support retrospective and concurrent reviews of high-cost admissions and outlier cases * Collaborate with utilization ...

MMC Group

DRG Auditor

San Antonio, TX · Remote

As members of the DRG Validation Team and working remotely, incumbents will be responsible for ... strong data analysis skills * Working knowledge of computer functions and applications such as ...

Zelis

Ops Analyst, DRG

Plano, TX

Position Overview The Operations Analyst, DRG will provide daily operational support to the Expert Claims Review team, including the itemized bill review and DRG validation teams. Responsibilities ...

Zelis

Ops Analyst, DRG

Boston, MA

Position Overview The Operations Analyst, DRG will provide daily operational support to the Expert Claims Review team, including the itemized bill review and DRG validation teams. Responsibilities ...

Zelis

Ops Analyst, DRG

Morristown, NJ · On-site

Position Overview The Operations Analyst, DRG will provide daily operational support to the Expert Claims Review team, including the itemized bill review and DRG validation teams. Responsibilities ...

Zelis

Ops Analyst, DRG

Atlanta, GA

Position Overview The Operations Analyst, DRG will provide daily operational support to the Expert Claims Review team, including the itemized bill review and DRG validation teams. Responsibilities ...

Zelis

Ops Analyst, DRG

Saint Louis, MO

Position Overview The Operations Analyst, DRG will provide daily operational support to the Expert Claims Review team, including the itemized bill review and DRG validation teams. Responsibilities ...

Zelis

Ops Analyst, DRG

Saint Petersburg, FL

Position Overview The Operations Analyst, DRG will provide daily operational support to the Expert Claims Review team, including the itemized bill review and DRG validation teams. Responsibilities ...

Zelis

Ops Analyst, DRG

Saint Petersburg, FL · On-site

Position Overview The Operations Analyst, DRG will provide daily operational support to the Expert Claims Review team, including the itemized bill review and DRG validation teams. Responsibilities ...

Software Development/Technology

Be Seen First

DRG Coding Validator

Franklin, TN · Remote

$105K - $115K/yr

The DRG Coding Validator integrates advanced clinical nursing knowledge with expert inpatient ... Provide clinical support and expertise to other investigative and analytical areas. * Will be ...

Jzanus Consulting

DRG Validator- Remote

Garden City, NY · Remote

$85K/yr

The DRG Validation position requires an extensive background in inpatient DRG coding with a deep ... Responsible and self-sufficient with strong analytical and research skills. Must be able to meet or ...

Zelis

Inpatient DRG Reviewer

Atlanta, GA

$79K - $99K/yr

Conduct reviews on inpatient DRG claims as they compare with medical records ICD-10 Official Coding ... Experience conducting root cause analysis and identifying solutions * Strong organization skills ...

Zelis

Inpatient DRG Reviewer

Saint Petersburg, FL · On-site

$79K - $99K/yr

Conduct reviews on inpatient DRG claims as they compare with medical records ICD-10 Official Coding ... Experience conducting root cause analysis and identifying solutions * Strong organization skills ...

Zelis

Inpatient DRG Reviewer

Plano, TX

$79K - $99K/yr

Conduct reviews on inpatient DRG claims as they compare with medical records ICD-10 Official Coding ... Experience conducting root cause analysis and identifying solutions * Strong organization skills ...

Zelis

Inpatient DRG Reviewer

Morristown, NJ

$79K - $99K/yr

Conduct reviews on inpatient DRG claims as they compare with medical records ICD-10 Official Coding ... Experience conducting root cause analysis and identifying solutions * Strong organization skills ...

Zelis

Inpatient DRG Reviewer

Saint Louis, MO

$79K - $99K/yr

Conduct reviews on inpatient DRG claims as they compare with medical records ICD-10 Official Coding ... Experience conducting root cause analysis and identifying solutions * Strong organization skills ...

Zelis

Inpatient DRG Reviewer

Boston, MA

$79K - $99K/yr

Conduct reviews on inpatient DRG claims as they compare with medical records ICD-10 Official Coding ... Experience conducting root cause analysis and identifying solutions * Strong organization skills ...

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How much do drg analyst jobs pay per year?

As of Jun 15, 2026, the average yearly pay for drg analyst in the United States is $73,261.00, according to ZipRecruiter salary data. Most workers in this role earn between $52,500.00 and $87,000.00 per year, depending on experience, location, and employer.

What are the typical daily responsibilities of a DRG Analyst?

As a DRG Analyst, your daily tasks usually include reviewing patient medical records to ensure accurate diagnosis and procedure coding, assigning the appropriate DRG for billing, and analyzing trends in hospital reimbursement data. You'll collaborate closely with coding staff, physicians, and billing departments to resolve discrepancies and improve accuracy. Additionally, you may conduct audits and provide education on coding updates and regulatory changes. This role is detail-oriented and critical for ensuring compliance with healthcare regulations and optimizing revenue for healthcare organizations.

What is a DRG Analyst job?

A DRG (Diagnosis-Related Group) Analyst is a healthcare professional responsible for reviewing medical records, coding diagnoses and procedures, and ensuring accurate reimbursement from insurance payers. They analyze patient data to classify hospital cases into DRGs for billing and regulatory compliance. DRG Analysts work closely with medical coders, billing teams, and compliance officers to optimize claims processing and minimize revenue loss. Their role is crucial in maintaining financial stability and regulatory adherence for healthcare institutions.

What are the key skills and qualifications needed to thrive in the Drg Analyst position, and why are they important?

To thrive as a DRG Analyst, you need a deep understanding of medical coding, healthcare reimbursement systems, and DRG (Diagnosis-Related Group) assignment, typically supported by a degree in health information management or a related field. Familiarity with ICD-10 coding, hospital billing software, and certification such as Certified Coding Specialist (CCS) are often required. Attention to detail, analytical thinking, and effective communication skills help you navigate complex documentation and collaborate with healthcare teams. These abilities are essential to ensure accurate coding, maximize reimbursement, and maintain healthcare compliance.

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What cities are hiring for Drg Analyst jobs? Cities with the most Drg Analyst job openings:
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Drg Analyst jobs near you
Infographic showing various Drg Analyst job openings in the United States as of June 2026, with employment types broken down into 1% Locum Tenens, 94% Full Time, and 5% Part Time. Highlights an 81% Physical, 8% Hybrid, and 11% Remote job distribution, with an average salary of $73,261 per year, or $35.2 per hour.
DRG Manager

DRG Manager

Machinify

Remote

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 4 days ago

Job description

Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. We're constantly reimagining what's possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.
About the Opportunity
At Machinify, we're constantly reimagining what's possible in our industry-creating disruptively simple, powerfully clear ways to maximize our clients' financial outcomes today and drive down healthcare costs tomorrow. As part of the Complex Payment Solutions Team, you will, as the DRG Manager, be responsible for the development and management of our clinical solutions, including MS and APR-DRG validation. This role requires expertise in healthcare payment methodologies and audit and review criteria to target key claims for review and recovery. Key responsibilities include inventory and team management, implementation support, client support, research, and management. This role requires a proactive and strategic thinker with strong leadership and analytical skills to drive the success of our clinical solutions and ensure optimal team performance.
What you'll do
  • Enhance and Review Clinical Solutions: Utilize expertise to assist in the enhancement and review of readmissions, place of service, and other clinical solutions.
  • Collaborative Development: Work with a multi-disciplinary team of programmers, operations staff, product leaders, and auditors to bring DRG process ideas from creation to implementation.
  • Regulatory Monitoring: Assess and adjust written rules by monitoring their effectiveness, keeping up with regulatory updates, and making necessary changes.
  • Team Leadership: Lead the DRG team by providing guidance, counsel, and development plans to ensure long-term retention and professional growth of DRG staff.
  • Claims Review Management: Oversee the entire process of clinical claims review, understanding various client configurations and workflows.
  • Operational Oversight: Manage scheduling, reporting to management, issue resolution, and execution of plans.
  • Work Coordination: Assign and prioritize work, set goals, and coordinate daily activities of the team. Provide regular updates and communication through one-on-one and team meetings.
  • Performance Monitoring: Monitor individual and team results to ensure timely completion of work in accordance with department standards and medical policy guidelines.
  • Analytical Problem-Solving: Demonstrate analytical skills to identify problems and trends, develop solutions, and implement action plans.
  • Policy and Process Development: Develop departmental policies, processes, and training standards.
  • Support and Evidence: Provide internal and external partners with evidence and references supporting industry standards, auditing guidelines, and review stances.
  • Performance Reporting: Provide reports on key performance indicators, including quality scores, workflows, savings, revenue projections, and inventory on a predetermined schedule.
  • Solution Development: Collaborate with a multi-disciplinary team to suggest solution development, including operations, product, data analytics, and technology.
  • Timeline Management: Set timelines and ensure communication on progress, tracking delivery, and escalating roadblocks or dependencies.
  • Program Deployment: Design and deploy effective programs/solutions to identify and correct claims with aberrant results, providing feedback to resolve root causes.
  • Research and Special Projects: Assist with research, special projects, and ad hoc claim reviews as needed.
  • Other Duties: Perform other duties as assigned.

What you'll bring
  • Bachelor's degree (health administration, business, nursing)
  • Equivalent experience of 5+ years in healthcare billing and coding
  • Equivalent experience of 3+ years in claims auditing and recovery auditing
  • Proven experience working within a team, sharing DRG audit process knowledge with sales, marketing, and development teams
  • Proven knowledge of classification systems, including MSDRG, APR DRG, AP DRG, and outpatient payment systems such as APCs and EAPGs
  • Demonstrated curiosity and mastery in understanding the root cause of events and behaviors
  • Strong experience in data utilization and insights
  • Experience independently structuring and executing complex analyses
  • Familiarity with Milliman and InterQual guidelines
  • Expertise in DRG validation
  • Experience in production and team management
  • Experience with Readmission reviews
  • Ability to work efficiently and effectively with minimal supervision
  • High standards of quality and attention to detail
  • Deep understanding of Medicare and Commercial coding rules, regulations, and prospective payment systems
  • Superior knowledge of healthcare coding, billing, and reimbursement
  • Expert knowledge of clinical criteria documentation requirements
  • Subject matter expertise in APR-DRG validation, Readmissions, and Place of Service

What we offer
  • Work from anywhere in the US! Machinify is digital-first.
  • Top Medical/Dental/Vision offerings
  • FSA/HSA
  • Tuition reimbursement
  • Competitive salary, 401(k) with company match
  • Unlimited PTO
  • Additional health and wellness benefits and perks
  • Flexible and trusting environment where you'll feel empowered to do your best work

The salary for this position is based on an array of factors unique to each candidate: Such as years and depth of experience, set skills, certifications, etc. We are hiring for different levels, and our Recruiting team will let you know if you qualify for a different role/range. Salary is one component of the total compensation package, which includes meaningful equity, excellent healthcare, flexible time off, and other benefits and perks.
Pay range: $125,000-$140,000 USD, plus annual bonus.
Equal Employment Opportunity at Machinify
We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace. Machinify is an employment at will employer. We participate in E-Verify as required by applicable law. In accordance with applicable state laws, we do not inquire about salary history during the recruitment process. If you require a reasonable accommodation to complete any part of the application or recruitment process, please let our recruiters know. See our Candidate Privacy Notice at: https://www.machinify.com/candidate-privacy-notice/

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