DRG Coding RN Reviewer / Auditor (RN)
100% Remote | U.S. Based | Full-Time | Up to $95,000 + Comprehensive Benefits

A nationally recognized healthcare organization specializing in payment integrity and clinical review services is seeking an experienced RN DRG Coding Reviewer/Auditor to join its growing team. This is a fully remote, full-time permanent role for candidates living in the United States.

This position offers a Monday–Friday schedule during standard business hours, competitive salary up to $95,000, and a strong benefits package. The role focuses on ensuring the accuracy of inpatient coding and DRG assignment while supporting healthcare quality and compliance.

Position Overview

The DRG Coding Reviewer/Auditor will review inpatient claims to validate ICD-10-CM/PCS coding and ensure accurate MS-DRG and APR-DRG assignment. This role requires strong analytical skills, attention to detail, and the ability to work independently in a remote environment.

Key Responsibilities

• Analyze and review inpatient claims to validate ICD-10-CM/PCS codes and confirm proper DRG assignment.

• Follow Official Coding and Reporting Guidelines to ensure accurate billing and documentation.

• Perform comprehensive initial reviews in accordance with standard operating procedures and departmental guidelines.

• Identify cases requiring clinical validation or physician review and collaborate with physician reviewers as needed.

• Prioritize workload and manage assignments independently to meet productivity expectations.

• Participate in required department meetings and training sessions.

• Complete additional duties or special projects as assigned.

Performance Expectations

• Track and report daily productivity.

• Meet or exceed established review productivity standards.

• Maintain 95% accuracy in claim reviews.

• Work a 7.5-hour workday within company core hours.

• Follow all organizational policies and compliance standards.

Qualifications

• Registered Nurse Licensed in State in US required
• Coding Certification required (one of the following):

  • CCS – Certified Coding Specialist OR

  • CIC – Certified Inpatient Coder

• Coursework in medical terminology, anatomy, pathophysiology, pharmacology, and medical coding.

• Minimum 3 years of experience in:

  • MS-DRG and APR-DRG validation

  • Acute care inpatient coding or auditing

• Experience with payment integrity DRG validation strongly preferred.

• Strong knowledge of:

  • Official Coding & Reporting Guidelines

  • AHA Coding Clinic guidance

  • CMS regulatory compliance standards

• Proficiency with Outlook, Word, Excel, and other common applications.

• Excellent written and verbal communication skills.

• Ability to work independently and manage multiple tasks in a remote setting.

• Maintain professional coding credentials through continuing education.

Remote Work Requirements

• High-speed internet connection (100 Mbps recommended).

• Secure Wi-Fi and a private workspace to protect PHI/HIPAA information.

• Ability to work at a computer for extended periods.

Schedule & Compensation

• 100% Remote – Must reside in the United States

• Monday–Friday | Standard business hours

• Full-time permanent role

• Salary up to $95,000, depending on experience

• Comprehensive benefits package