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Drg Validator Jobs (NOW HIRING)

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 ...

Centene

DRG Reviewer

Saint Louis, MO · On-site +1

$70K - $126K/yr

Operates with significant autonomy in supporting DRG validation reviews and appeals, interpreting regulatory requirements, and making authoritative decisions to ensure compliance with all applicable ...

Centene

DRG Reviewer

Florissant, MO · On-site +1

$70K - $126K/yr

Operates with significant autonomy in supporting DRG validation reviews and appeals, interpreting regulatory requirements, and making authoritative decisions to ensure compliance with all applicable ...

Astrana Health, Inc.

$33 - $38/hr

DRG Coder Department: HS - UM Employment Type: Full Time Location: 600 City Parkway West 10th Floor ... Conduct coding validation and auditing to ensure compliance with payer and regulatory requirements

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

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 ...

Astrana Health, Inc.

DRG Coder

Orange, CA

$33 - $38/hr

Description The DRG Coder is responsible for reviewing inpatient medical records and accurately ... Conduct coding validation and auditing to ensure compliance with payer and regulatory requirements

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

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 ...

Astrana Health

DRG Coder

$33 - $38/hr

DRG Coder The Senior DRG Coder is responsible for reviewing inpatient medical records and ... Conduct coding validation and auditing to ensure compliance with payer and regulatory requirements

EnableComp

DRG Auditor (REMOTE)

OR · Remote

$28 - $31.75/hr

Position Summary The DRG Auditor is responsible for reviewing post-billed inpatient claims to identify and validate missed reimbursement opportunities based on diagnosis and procedure coding. Working ...

EnableComp

DRG Auditor (REMOTE)

$28 - $31.75/hr

Position Summary The DRG Auditor is responsible for reviewing post-billed inpatient claims to identify and validate missed reimbursement opportunities based on diagnosis and procedure coding. Working ...

EnableComp

DRG Auditor (REMOTE)

Franklin, TN · Remote

$27 - $30.50/hr

Position Summary The DRG Auditor is responsible for reviewing post-billed inpatient claims to identify and validate missed reimbursement opportunities based on diagnosis and procedure coding. Working ...

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Drg Validator information

What is a DRG Validator?

A DRG Validator reviews and validates Diagnosis-Related Group (DRG) codes assigned to patient records for accuracy and compliance with coding guidelines. They ensure that medical documentation supports the assigned codes, which directly impact hospital reimbursement and reporting. DRG Validators typically work in healthcare facilities, insurance companies, or auditing firms and must have expertise in medical coding, billing regulations, and clinical documentation.

What does a DRG Validator do?

As a DRG Validator, your typical day involves reviewing patient medical records and coding assignments to ensure accurate DRG classification and compliance with coding guidelines. You may collaborate closely with medical coders, clinical documentation improvement specialists, and healthcare providers to clarify documentation or resolve discrepancies. The role often requires you to stay updated on coding regulations and participate in quality assurance meetings. Attention to detail and thorough documentation are essential, as your work directly impacts hospital reimbursement and data integrity.

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

To thrive as a DRG Validator, you need a strong understanding of medical coding, clinical documentation, and Diagnosis Related Group (DRG) assignment, often supported by an RHIA, RHIT, or CCS certification. Familiarity with coding software (such as 3M or TruCode), electronic medical record (EMR) systems, and current ICD-10-CM/PCS coding standards is essential. Attention to detail, analytical thinking, and effective communication are key soft skills in this position. These abilities are crucial to accurately validate coding, ensure compliance with regulatory standards, and reduce reimbursement errors.

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Drg Validator jobs near you
Infographic showing various Drg Validator job openings in the United States as of August 2026, with employment types broken down into 80% Full Time, and 20% Contract. Highlights an 40% In-person, and 60% Remote job distribution.

DRG Clinical Validation Nurse

MedReview

Manhattan, NY • On-site, Remote

$85K - $95K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 5 days ago

Job description

Position Summary
At MedReview, our mission is to bring accuracy, accountability, and clinical excellence to healthcare. As such, we are a leading authority in payment integrity solutions including 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 motivated, with strong clinical and coding background. This individual must have excellent communication skills and an analytical mindset to achieve and maintain high-level performance in a fast-paced environment.
This is a fulltime position (40 hours per week) Monday - Friday. You'll enjoy the flexibility to telecommute from anywhere within the United States. Training will be conducted virtually from your home.
If you are interested in this role with MedReview, please let us know. Here is what we are searching for:
Responsibilities:
  • Perform clinical validation by ensuring diagnosis codes billed by the provider are supported within the medical record
  • Must be able to interpret clinical guidelines/criteria and apply to clinical review
  • Solid understanding of anatomy and physiology, diagnostic and surgical procedures developed from specialized training and extensive experience with ICD-10-PCS code assignments
  • Demonstrates the ability to accurately interpret the medical record
  • Writes clear, accurate and concise rationales in support of findings
  • Maintains and manages case reviews with a high emphasis on quality
  • Demonstrates the ability to work in a high - volume production environment
  • Knowledge of health insurance business, industry terminology, and regulatory guidelines

Qualifications:
  • Minimum of two years' experience in clinical validation in a payment integrity setting required
  • May consider nurses with inpatient claims auditing experience or case management experience.
  • Unrestricted Registered Nurse with active RN licensure required
  • CCS (Certified Coding Specialist) or CIC (Certified Inpatient Coder) certification preferred
  • CCDS or CDIP Certification preferred
  • Knowledge of ICD-10 coding
  • Basic Knowledge of DRG validation and coding
  • Ability to use Windows PC with the ability to utilize multiple applications at the same time

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.

Salary Rate: $85,000 - 95,000/Annually.

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