DRG Coder
$68,640–$79,040 year
Remote · United States or Orange, California, United States
Job Summary
Senior DRG Coder responsible for reviewing inpatient medical records and accurately assigning ICD-10-CM/PCS codes to determine MS-DRG/APR-DRG assignments. Ensure coding accuracy, reimbursement integrity, and regulatory compliance. Conduct coding validation, identify documentation gaps, analyze denials and underpayments, support audits (RAC, Medicare Advantage, Medicaid, commercial payers), and collaborate with utilization management, case management, finance, and contracting teams to optimize reimbursement and cost containment. Provide education to coding staff and stakeholders, monitor coding guideline changes, prepare reports on coding accuracy and financial impact, and maintain HIPAA compliance. Remote-based in the U.S. with occasional in-person meetings; home office located in Orange, CA (600 City Parkway West, 10th Floor). The role targets a minimum of 5 years inpatient coding experience with advanced DRG validation/auditing experience and relevant credentials (CCS/RHIA/RHIT or CIC/CPC). The national target pay range is $33.00-$38.00 per hour, with compensation determined by location and experience.
Required Qualifications
- Associate’s degree in Health Information Management, Nursing, or related field
- Minimum of 5 years of inpatient coding experience
- Minimum of 2 years of advanced DRG validation, auditing, or hospital reimbursement experience
- Certifications One or more of the following required: CCS, RHIA, or RHIT from AHIMA; CIC or CPC from AAPC
- Have advanced knowledge of ICD-10-CM, ICD-10-PCS, MS-DRG, and APR-DRG methodologies
- Proficiency in coding software, EMR, and Microsoft Office
- Experience with Medicare Advantage, Medicaid, and commercial health plans
- Experience in a delegated IPA, MSO, or managed care environment
- Strong analytical, organizational, and problem-solving skills
- Ability to interpret complex clinical documentation
- Excellent written and verbal communication skills
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