Senior DRG Coder – Remote & Reimbursement Expert

Visa Hunt; United States; On-site; USD 94,558,000 - 108,886,000; Full time

Job summary

Astrana Health is seeking a Senior DRG Coder to review inpatient records and assign ICD-10-CM/PCS codes for accurate DRG determination in an IPA/MSO setting. You will collaborate with utilization management, finance, and CDI teams to support payment integrity and compliance.

The role requires 5+ years inpatient coding, DRG validation experience, and professional certifications (CCS/RHIA/RHIT/CIC/CPC). Remote-based in the U.S.

Qualifications

• Bachelor-level or equal degree in HIM or related field is required.
• Minimum 5 years inpatient coding experience and 2+ years DRG validation/auditing.
• Certifications CCS, RHIA, RHIT, CIC or CPC are required.
• Strong knowledge of ICD-10 coding systems and DRG methodologies.
• Proficiency with coding software, EMR systems, and MS Office.

Responsibilities

• Review inpatient records and assign accurate diagnosis and procedure codes.
• Determine MS-DRG or APR-DRG based on documentation.
• Conduct coding validation to ensure payer/regulatory compliance.
• Identify documentation gaps and communicate opportunities.
• Analyze denials and underpayments related to coding.
• Support retrospective and concurrent reviews of high-cost cases.
• Collaborate with management, finance, and contracting to optimize reimbursement.
• Assist audits including RAC, Medicare Advantage, Medicaid, and commercial payer reviews.
• Provide education and mentoring to coders and stakeholders.
• Monitor guideline changes and regulatory updates.
• Prepare reports on coding accuracy and financial impact.
• Maintain HIPAA compliance.
• Other duties as assigned.

Education

Associate’s degree in Health Information Management, Nursing, or related field

Minimum 5 years inpatient coding experience

Minimum 2 years DRG validation/auditing experience

CCS

RHIA

RHIT

CIC

CPC

ICD-10-CM / ICD-10-PCS knowledge

MS-DRG / APR-DRG methodologies

Coding software / EMR / MS Office

Tools

Microsoft Office

Electronic Medical Records

Job description

Astrana Health is seeking a Senior DRG Coder to review inpatient records and assign ICD-10-CM/PCS codes for accurate DRG determination in an IPA/MSO setting. You will collaborate with utilization management, finance, and CDI teams to support payment integrity and compliance.

The role requires 5+ years inpatient coding, DRG validation experience, and professional certifications (CCS/RHIA/RHIT/CIC/CPC). Remote-based in the U.S.