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Drg Validation Jobs (NOW HIRING)

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 understanding of the MS-DRG and APR-DRG payment systems. The validator is responsible for auditing ...

HCA Healthcare

DRG Validation Auditor

Caldwell, ID · On-site

$34.59 - $51.89/hr

Jump-start your career as a DRG Validation Auditor today with Parallon. Job Summary and Qualifications As a work from home Inpatient Coding Auditor, you will be responsible for performing internal ...

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.

All Med Search

DRG Validation Specialist

Nashville, TN

$40 - $45/hr

* Leads, coordinates and performs all functions of quality reviews (routine, pre-bill, policy driven and incentive plan driven) for inpatient coding across multiple HSCs * Assists in ensuring HSC ...

MedReview

DRG Clinical Validation Nurse

New York, NY · Remote

$85K - $95K/yr

... DRG Validation, Cost Outlier and Readmission reviews. We are seeking a registered nurse with experience in clinical validation to work within our coding department. Candidate should be highly ...

MedReview

DRG Clinical Validation Nurse

Manhattan, NY · On-site +1

$85K - $95K/yr

... DRG Validation, Cost Outlier and Readmission reviews. We are seeking a registered nurse with experience in clinical validation to work within our coding department. Candidate should be highly ...

HCA Healthcare

DRG Validation Auditor

Las Vegas, NV · On-site

$34.59 - $51.89/hr

Jump-start your career as a DRG Validation Auditor today with Parallon. Job Summary and Qualifications As a work from home Inpatient Coding Auditor, you will be responsible for performing internal ...

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.

Cotiviti

$45.67/hr

... Validation for our Inpatient audits. The ideal candidate for this position needs to have a coding/auditing background focused on Inpatient DRG Coding from a coding and billing perspective. This ...

Insight Global

DRG Auditor

South Jordan, UT · Remote

$95K/yr

Degree in RHIM, RHIA, RHIT with medical coding degree or just CCS or CPC is fine with strong clinical knowledge Insight Global is seeking a DRG Validation Auditor for one of our clients to sit 100 ...

Machinify

DRG Manager

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 ...

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Drg Validation information

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$15

$26

$45

How much do drg validation jobs pay per hour?

As of Jul 14, 2026, the average hourly pay for drg validation in the United States is $26.09, according to ZipRecruiter salary data. Most workers in this role earn between $19.23 and $30.53 per hour, depending on experience, location, and employer.

What is DRG validation?

DRG validation is the process of reviewing medical records and clinical documentation to ensure that the assigned Diagnosis-Related Group (DRG) code accurately reflects the patient's diagnoses and procedures during a hospital stay. This process is crucial for accurate hospital reimbursement, compliance with regulations, and maintaining data integrity. DRG validation helps detect and correct coding errors, supports quality reporting, and prevents potential billing issues or audits.

What are the typical challenges faced in a DRG Validation role, and how can professionals effectively address them?

DRG Validation professionals often encounter challenges such as ensuring accurate clinical documentation, interpreting complex medical records, and staying current with changing coding guidelines and regulations. To effectively address these challenges, it's important to maintain ongoing education, collaborate closely with clinical staff to clarify documentation, and utilize robust auditing tools. A strong attention to detail and proactive communication with healthcare providers help ensure the integrity of data and compliance with industry standards.

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

To excel as a DRG Validator, you need a strong understanding of medical coding, clinical documentation, and healthcare regulations, usually backed by a credential such as RHIT, CCS, or CPC. Familiarity with coding classification systems (ICD-10-CM/PCS), DRG grouping software, and electronic health record (EHR) systems is essential. Attention to detail, analytical thinking, and effective communication are crucial soft skills for ensuring coding accuracy and collaborating with clinical staff. These skills ensure correct reimbursement, compliance with regulations, and support the financial health of healthcare organizations.

What is the difference between Drg Validation vs Medical Coder?

AspectDrg ValidationMedical Coder
CredentialsTypically requires coding certifications and knowledge of DRG systemsRequires coding certifications like CPC, CCS, or equivalent
Work EnvironmentHospitals, insurance companies, or healthcare consulting firmsHospitals, clinics, and billing companies
Industry UsageFocuses on validating DRG assignments for reimbursementFocuses on assigning accurate medical codes for diagnoses and procedures
Search/Comparison IntentUnderstanding DRG validation roles and responsibilitiesUnderstanding medical coding roles and responsibilities

Drg Validation specialists focus on verifying DRG assignments for billing and reimbursement, requiring knowledge of coding and healthcare regulations. Medical Coders assign specific medical codes to diagnoses and procedures, often requiring similar certifications. While both roles involve coding, Drg Validation emphasizes DRG accuracy for reimbursement, whereas Medical Coders handle detailed coding tasks across various medical documentation.

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What states have the most Drg Validation jobs? States with the most job openings for Drg Validation jobs include:
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Drg Validation jobs near you
DRG Validation Coding Auditor

DRG Validation Coding Auditor

Ensemble Health Partners, Inc.

Remote

$69K - $104K/yr

Full-time

Medical, Retirement

Re-posted 9 days ago

Ensemble Health Partners rating

6.5

Company rating: 6.5 out of 10

Based on 239 frontline employees who took The Breakroom Quiz

140th of 148 rated financial services

Job description

Thank you for considering a career at Ensemble!
Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country.
Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference!
O.N.E Purpose:
  • Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations.
  • Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation.
  • Striving for Excellence: Execute at a high level by demonstrating our "Best in KLAS" Ensemble Difference Principles and consistently delivering outstanding results.

The Opportunity:
CAREER OPPORTUNITY OFFERING:
  • Bonus Incentives
  • Paid Certifications
  • Tuition Reimbursement
  • Comprehensive Benefits
  • Career Advancement
  • This position pays between $69,400 to $104,100 annually based on experience. Final compensation will be determined based on experience.

The Inpatient/DRG Validation Coding Auditor performs documentation and coding audits for all acute inpatient services for clients. Identifies coding errors, compliance, and educational opportunities, and optimizes reimbursement by ensuring that the diagnosis/procedure codes and supporting documentation accurately support the services rendered and comply with ethical coding standards/guidelines and regulatory requirements. Performs independent reviews, interprets medical records, and applies in-depth knowledge of coding principles to determine billing/coding/documentation issues and quality concerns. Demonstrates high level of expertise in researching requirements necessary to make compliant recommendations.
  • Has an extensive understanding of reimbursement guidelines, specifically related to DRG (MS, APR, Tricare, etc.) payment systems.
  • Conducts DRG (ex. MS, APR, Tricare) coding and clinical reviews to verify the accuracy of coding, DRG assignment and clinical indicators in accordance with coding and documentation guidelines. Ensures that the assigned DRG reflects the severity of the patient's condition, and the resources used during their hospital stay.
  • Assesses whether the clinical documentation supports the coded diagnoses and procedures. Verifies that the medical record adequately justifies the assigned DRG.
  • Combines medical record coding guidelines, clinical principles, and industry trends to explain any recommended changes needed by coders. Works closely with CDI (Clinical Documentation Integrity) specialists to determine if there are documentation and/or query opportunities.
  • Maintains productivity and quality goals as set by audit leaders.
  • Writes clear, accurate and concise recommendations in support of findings while providing feedback and education to acute inpatient coders, referencing current ICD-10-CM/PCS Official Coding Guidelines and AHA Coding Clinics.
  • Ensures acute inpatient coding audits are completed accurately and timely by meeting client turn around and audit quality expectations.
  • Responsible for maintaining current certification(s), CEU's, and up-to-date knowledge of coding guidelines.
  • Completes required education through internal application, compliance training and other mandatory educational requirements.
  • Use proprietary systems and encoder tools efficiently and accurately to make audit determinations, generate audit recommendations through workflow processes accurately.
  • Identifies any potential overpayments or underpayments by analyzing claims, on a 30-day lookback, to identify any discrepancies between billed DRGs and the actual services provided.
  • Leverages ICD-10 coding expertise, clinical guidelines, and proprietary tools to substantiate conclusions. Continues to stay informed about changes in acute inpatient coding regulations and reimbursement policies.
  • Identifies potential opportunities, outside of the normal scope, where there may be additional recoveries or compliance concerns. Shares and assists in development of concepts and or process improvement, tools, etc.

Experience We Love:
  • 5+ years of coding experience.
  • 3+ years of facility coding audit experience (such as DRG and APC Validation).
  • Proficiency in multiple EMR's, encoders, and the Microsoft Office suite.
  • Educated in HIPAA regulations; must maintain strict confidentiality of patient and client information.
  • Consistently achieves quality and productivity standards.
  • Ability to organize and complete work in a timely manner.
  • Ability to read, write and effectively communicate in English.
  • Ability to understand medical/surgical terminology.
  • Above average written and verbal communication skills.
  • Must be inquisitive and demonstrate openness to innovation including AI to explore better processes and ways to alleviate friction and improve patient and client experiences.
  • This is a remote position; however, candidates must be willing and able to travel to and work onsite at client, temporary, or corporate office locations as business needs require.

Minimum Education:
  • Bachelors Degree or Equivalent Experience

Certification Required:
Candidates must have and keep current at least one of the following professional certifications (CCS Preferred):
  • CPC (Certified Professional Coder)
  • CCS (Certified Coding Specialist)
  • RHIA (Registered Health Information Administrator)
  • RHIT (Registered Health Information Technician)

#LI-HB1
#LI-REMOTE
Join an award-winning company
Five-time winner of "Best in KLAS" 2020-2022, 2024-2025
Black Book Research's Top Revenue Cycle Management Outsourcing Solution 2021-2024
22 Healthcare Financial Management Association (HFMA) MAP Awards for High Performance in Revenue Cycle 2019-2024
Leader in Everest Group's RCM Operations PEAK Matrix Assessment 2024
Clarivate Healthcare Business Insights (HBI) Revenue Cycle Awards for strong performance 2020, 2022-2023
Energage Top Workplaces USA 2022-2024
Fortune Media Best Workplaces in Healthcare 2024
Monster Top Workplace for Remote Work 2024
Great Place to Work certified 2023-2024
  • Innovation
  • Work-Life Flexibility
  • Leadership
  • Purpose + Values

Bottom line, we believe in empowering people and giving them the tools and resources needed to thrive. A few of those include:
  • Associate Benefits - We offer a comprehensive benefits package designed to support the physical, emotional, and financial health of you and your family, including healthcare, time off, retirement, and well-being programs.
  • Our Culture - Ensemble is a place where associates can do their best work and be their best selves. We put people first, last and always. Our culture is rooted in collaboration, growth, and innovation.
  • Growth - We invest in your professional development. Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement.
  • Recognition - We offer quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company.

Ensemble is an equal employment opportunity employer. It is our policy not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender, gender identity, religion, national origin, age, disability, military or veteran status, genetic information or any other basis protected by applicable federal, state, or local laws. Ensemble also prohibits harassment of applicants or employees based on any of these protected categories.
Ensemble provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law. If you require accommodation in the application process, please contact TA@ensemblehp.com.
This posting addresses state specific requirements to provide pay transparency. Compensation decisions consider many job-related factors, including but not limited to geographic location; knowledge; skills; relevant experience; education; licensure; internal equity; time in position. A candidate entry rate of pay does not typically fall at the minimum or maximum of the role's range.
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