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Drg Reviewer Jobs (NOW HIRING)

MedReview

DRG Reviewer

Manhattan, NY · On-site +1

$85K - $90K/yr

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 ...

MedReview

DRG Reviewer

Manhattan, NY · Remote

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 ...

Machinify

DRG Reviewer

$35.50 - $47.75/hr

About the Opportunity As part of the Complex Payment Solutions Team, you will, as a DRG Reviewer, be a key contributor responsible for conducting thorough DRG payment validation reviews, including ...

Zelis

Inpatient DRG Reviewer

Saint Louis, MO · On-site

$79K - $99K/yr

Conduct reviews on inpatient DRG claims as they compare with medical records ICD-10 Official Coding Guidelines, AHA Coding Clinic and client specific coverage policies. Conduct prompt claim review to ...

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 Guidelines, AHA Coding Clinic and client specific coverage policies. Conduct prompt claim review to ...

Zelis

Inpatient DRG Reviewer

Boston, MA · On-site

$79K - $99K/yr

Conduct reviews on inpatient DRG claims as they compare with medical records ICD-10 Official Coding Guidelines, AHA Coding Clinic and client specific coverage policies. Conduct prompt claim review to ...

Zelis

Inpatient DRG Reviewer

Plano, TX · On-site

$79K - $99K/yr

Conduct reviews on inpatient DRG claims as they compare with medical records ICD-10 Official Coding Guidelines, AHA Coding Clinic and client specific coverage policies. Conduct prompt claim review to ...

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 Guidelines, AHA Coding Clinic and client specific coverage policies. Conduct prompt claim review to ...

Zelis

Inpatient DRG Reviewer

Saint Petersburg, FL

$79K - $99K/yr

Conduct reviews on inpatient DRG claims as they compare with medical records ICD-10 Official Coding Guidelines, AHA Coding Clinic and client specific coverage policies. Conduct prompt claim review to ...

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 Guidelines, AHA Coding Clinic and client specific coverage policies. Conduct prompt claim review to ...

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 Guidelines, AHA Coding Clinic and client specific coverage policies. Conduct prompt claim review to ...

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 Guidelines, AHA Coding Clinic and client specific coverage policies. Conduct prompt claim review to ...

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 Guidelines, AHA Coding Clinic and client specific coverage policies. Conduct prompt claim review to ...

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 Guidelines, AHA Coding Clinic and client specific coverage policies. Conduct prompt claim review to ...

MMC Group

DRG Auditor

San Antonio, TX · Remote

As members of the DRG Validation Team and working remotely, incumbents will be responsible for reviewing medical records to determine the accuracy of coding and reimbursement for clinical services ...

Machinify

DRG QA and Trainer

$85K - $95K/yr

Review and audit the work of new and existing DRG Reviewers to ensure accuracy, compliance, and alignment with established coding and clinical validation guidelines. * Provide constructive, detailed ...

Empower AI

Medical Reviewer III (Medicare/DRG)

Medical Review Specialist III (Medicare DRG) Empower AI gives federal agency leaders the tools to elevate the potential of their workforce with a direct path for meaningful transformation.

Emory Healthcare

Inpatient DRG Coding Auditor

Atlanta, GA · On-site

$26 - $29.50/hr

Reviews inpatient medical records for select payer populations post-discharge and pre-bill; audits the accuracy and completeness of diagnosis and procedure coding, DRG assignment, and abstracted data ...

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How much do drg reviewer jobs pay per hour?

As of Jul 14, 2026, the average hourly pay for drg reviewer in the United States is $29.88, according to ZipRecruiter salary data. Most workers in this role earn between $22.60 and $36.54 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a DRG Reviewer, and why are they important?

To thrive as a DRG Reviewer, you need a solid background in medical coding, clinical documentation, and healthcare reimbursement, often supported by credentials such as RHIA, RHIT, CCS, or RN licensure. Familiarity with ICD-10-CM/PCS codes, MS-DRG grouping software, and hospital information systems is typically required. Attention to detail, analytical thinking, and effective communication are valuable soft skills for ensuring accurate coding and collaboration with clinical staff. These skills are crucial for optimizing reimbursement, maintaining regulatory compliance, and supporting quality healthcare delivery.

What is a DRG reviewer job description?

A DRG reviewer evaluates medical records and assigns Diagnosis-Related Groups (DRGs) to ensure accurate hospital billing and reimbursement. They analyze clinical documentation, verify coding accuracy, and may use coding software, often requiring knowledge of medical coding standards and certifications such as CPC or CCS. The role typically involves reviewing cases within a healthcare setting and adhering to regulatory guidelines.

How much do DRG auditors make?

DRG reviewers or auditors typically earn between $50,000 and $80,000 annually, depending on experience, location, and employer. Senior or specialized auditors with certifications can earn higher salaries, and the role often requires knowledge of coding, billing, and healthcare regulations.

How to become a DRG validator?

To become a DRG (Diagnosis-Related Group) validator, candidates typically need a background in healthcare, coding, or medical billing, along with knowledge of DRG classification systems. Certification in medical coding or billing, such as CPC or CCS, is often required, and experience with hospital coding or clinical documentation improves job prospects. Strong analytical skills and familiarity with coding software are also beneficial.

What is a DRG Reviewer?

A DRG Reviewer is a healthcare professional who evaluates patient medical records to ensure accurate assignment of Diagnosis-Related Groups (DRGs) for billing and reimbursement purposes. They review clinical documentation, verify coding accuracy, and ensure compliance with regulations and guidelines. DRG Reviewers play a crucial role in optimizing hospital revenue while maintaining adherence to healthcare standards. Their work supports accurate hospital payments and helps prevent billing errors or fraud.

How to get a job as a reviewer?

To become a DRG reviewer, candidates typically need a background in healthcare, medical coding, or clinical documentation, along with relevant certifications such as CPC or CCS. Experience in medical record review and knowledge of diagnosis-related groups (DRGs) are also important, and job opportunities are often found through healthcare organizations, government agencies, or specialized staffing agencies.

How does a DRG Reviewer typically collaborate with clinical and coding teams to ensure accurate reimbursement?

As a DRG Reviewer, collaboration with both clinical staff and medical coders is essential for ensuring accurate assignment of Diagnosis-Related Groups (DRGs) and appropriate reimbursement. DRG Reviewers regularly communicate with physicians to clarify clinical documentation and work closely with coding teams to resolve discrepancies or ambiguities in medical records. This role often involves participating in interdisciplinary meetings, educating staff on documentation requirements, and providing feedback to improve coding accuracy, which helps maintain compliance and optimize hospital revenue.
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Drg Reviewer jobs near you
DRG Reviewer

DRG Reviewer

MedReview

Manhattan, NY • On-site, Remote

$85K - $90K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 7 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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