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Drg Validation Auditor Jobs (NOW HIRING)

MMC Group

DRG Auditor

San Antonio, TX · Remote

DRG Validation Auditors are charged with rendering appropriate, well-supported, and thoroughly-documented decisions, which may result in identification of improper payments (overpayments and ...

Parallon

DRG Validation Auditor

Franklin, TN · On-site

As a DRG Validation Auditor with Parallon you can be a part of an organization that is devoted to giving back! Candidates must have a background in Facility Inpatient Coding and DRG Validation. Job ...

Parallon

DRG Validation Auditor

Murfreesboro, TN · On-site

As a DRG Validation Auditor with Parallon you can be a part of an organization that is devoted to giving back! Candidates must have a background in Facility Inpatient Coding and DRG Validation. Job ...

R1

DRG Validation Auditor I

$48K - $81K/yr

As our DRG Validation Auditor I , your primary role will be auditing inpatient cases for DRG validation and/or documentation improvement. This consists of reviewing accounts in proprietary software ...

Parallon

DRG Validation Auditor

Nashville, TN · On-site

As a DRG Validation Auditor with Parallon you can be a part of an organization that is devoted to giving back! Candidates must have a background in Facility Inpatient Coding and DRG Validation. Job ...

Parallon

DRG Validation Auditor

Lebanon, TN · On-site

As a DRG Validation Auditor with Parallon you can be a part of an organization that is devoted to giving back! Candidates must have a background in Facility Inpatient Coding and DRG Validation. Job ...

Cotiviti

DRG Validation Auditor (Clinical & Coding)

$45.67/hr

Overview This auditing role will focus on Coding & Clinical Chart Validation for our Inpatient audits (DRG Validation). The ideal candidate for this position needs to have both a clinical (nurse) and ...

Cotiviti

$45.67/hr

Overview This auditing role will focus on Coding & Clinical Chart Validation for our Inpatient audits (DRG Validation). The ideal candidate for this position needs to have both a clinical (nurse) and ...

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Drg Validation Auditor information

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How much do drg validation auditor jobs pay per hour?

As of Aug 8, 2026, the average hourly pay for drg validation auditor in the United States is $38.60, according to ZipRecruiter salary data. Most workers in this role earn between $17.31 and $32.69 per hour, depending on experience, location, and employer.

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

To excel as a DRG Validation Auditor, you need a solid background in medical coding, clinical documentation, and healthcare regulations, often supported by credentials such as RHIA, RHIT, or CCS certification. Familiarity with coding software, electronic health records (EHRs), and Clinical Documentation Improvement (CDI) platforms is highly valuable. Strong analytical thinking, attention to detail, and effective communication are standout soft skills for this role. These skills are vital for ensuring accurate DRG assignments, compliance with regulatory standards, and optimizing healthcare reimbursement.

What is a DRG Validation Auditor?

A DRG Validation Auditor reviews medical records to ensure accurate assignment of Diagnosis-Related Groups (DRGs) for billing and reimbursement purposes. They verify coding accuracy, compliance with regulations, and adherence to payer guidelines. Their work helps prevent overpayments, underpayments, and potential fraud while ensuring healthcare providers receive appropriate reimbursement. DRG Validation Auditors typically have expertise in medical coding, clinical documentation, and healthcare regulations such as ICD-10 and Medicare guidelines.

What are the typical daily responsibilities of a DRG Validation Auditor?

As a DRG Validation Auditor, your day-to-day tasks will involve reviewing patient charts and medical records to ensure proper assignment of Diagnosis-Related Groups (DRGs) and that clinical documentation supports coding decisions. You'll regularly collaborate with coding professionals, clinical staff, and sometimes physicians to clarify discrepancies or gather additional information. Additional responsibilities often include preparing audit reports, tracking audit findings, and helping implement process improvements based on audit results. This role requires a keen eye for detail and the ability to work both independently and as part of a larger health information management or compliance team, making it an excellent fit for those who enjoy problem-solving and continuous learning.

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Drg Validation Auditor jobs near you
Infographic showing various Drg Validation Auditor job openings in the United States as of August 2026, with employment types broken down into 90% Full Time, 3% Part Time, 1% Temporary, and 6% Contract. Highlights an 87% Physical, 4% Hybrid, and 9% Remote job distribution, with an average salary of $80,278 per year, or $38.6 per hour.

DRG Auditor

MMC Group

San Antonio, TX • Remote

Full-time

Re-posted 20 days ago

Job description


Job Description:

A leader in providing clinical auditing services to public and commercial healthcare payers throughout the US, has openings for remote DRG Validation Auditors. 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 rendered to beneficiaries of various health plans, including Commercial, Medicare, and Medicaid Clients. DRG Validation Auditors are charged with rendering appropriate, well-supported, and thoroughly-documented decisions, which may result in identification of improper payments (overpayments and underpayments) on paid claims on behalf of the client from various providers of clinical services, including but not limited to acute care, long-term acute care, acute rehabilitation, and skilled nursing facilities, as well as other provider types and care settings. Initially, DRG Validation Auditors are prepared for the role through a detailed, well-defined training process, gaining knowledge and skills in methods for review of medical records and other provider documentation. Ongoing training and education are provided specific to audit processes, coding and reimbursement changes, and other topics as well. The DRG Validation Auditor reports to a DRG Validation Team Leader, who provides support, feedback, and guidance to DRG Validation Auditors. Moreover, quality assurance is provided through a well-defined review and quality management program performed by the Professional Development Team.


Specifically, DRG Validation Auditors will be responsible for the following:


  • Review inpatient medical records to validate the admit order, assignment and sequencing of ICD9-CM diagnosis and procedure codes, discharge status codes, and DRG assignment.

  • Provide a detailed rationale for every medical record review resulting in a DRG Review Results letter, including supporting references.

  • Follow proper procedure for referral to Clinical Nurse Auditor or Physician Advisor.

  • Utilize proper reference material, standards, and guidelines for coding.

  • Provide input to the Edit Development team on claims selection criteria.

  • Verify data received from client and work to resolve discrepancies.

  • If the contract requires onsite review, interact with Providers and other personnel in a professional manner.

  • Follow policies and processes

  • Comply with department standards regarding productivity and audit quality.

  • Perform other duties as assigned.



To be considered for these challenging roles, applicants must have a majority of the following skills, knowledge and abilities:


  • Possess current AHIMA credentials (RHIT/RHIA/CCS), with current CCS preferred

  • Demonstrate extensive knowledge of ICD-9-CM coding and DRG reimbursement, with a minimum of five years of inpatient coding experience

  • Have an understanding of Medicare, Medicaid, and commercial provider reimbursement methodologies, and possess strong data analysis skills

  • Working knowledge of computer functions and applications such as Microsoft Office (Outlook, Word, Excel) and Windows operating systems

  • Ability to write a well-reasoned review in a narrative style, with accurate spelling, grammar, punctuation, and sentence structure

  • Ability to adapt to changing priorities in order to meet Client requirements and productivity standards and deadlines

  • Ability to travel for additional training and on-site reviews on an as-needed basis

  • Since incumbents will work from their home-based offices, they must have their own access to high-speed Internet connectivity