Astrana Health

Technology-enabled platform delivering value-based care

DRG Coder

Clinical Support & Patient AdministrationUpdated on Nov 13

Full-timeCalifornia, USA$28 - $32 /hrRemote

About the Job

Requirements

An Associate’s degree in Health Information Management, Nursing, or a related field is required.
At least 5 years of inpatient coding experience is required.
At least 2 years of advanced DRG validation, auditing, or hospital reimbursement experience is required.
One or more of the following certifications is required: CCS, RHIA, or RHIT from the American Health Information Management Association, or CIC from AAPC.
Advanced knowledge of ICD-10-CM, ICD-10-PCS, MS-DRG, and APR-DRG methodologies is required.
Proficiency in coding software, electronic medical records, and Microsoft Office applications is required.

Responsibilities

Review inpatient hospital records and assign accurate diagnosis and procedure codes.
Determine the appropriate MS-DRG or APR-DRG assignment based on coding and clinical documentation.
Conduct coding validation and auditing to ensure compliance with payer and regulatory requirements.
Identify documentation gaps and communicate opportunities to providers, hospitals, and Clinical Documentation Improvement teams.
Analyze denials and underpayments related to coding and DRG assignment.
Support retrospective and concurrent reviews of high-cost admissions and outlier cases.
Collaborate with utilization management, case management, finance, and contracting teams to optimize reimbursement and cost containment.
Assist with internal and external audits, including RAC, Medicare Advantage, Medicaid, and commercial payer reviews.
Provide education and mentoring to coding staff and other stakeholders.
Monitor changes in coding guidelines, reimbursement methodologies, and regulatory requirements.
Prepare reports and summaries related to coding accuracy, financial impact, and audit findings.
Maintain confidentiality and comply with HIPAA and company policies.

Desired Qualifications

Experience working with Medicare Advantage, Medicaid, and commercial health plans is preferred.
Experience in a delegated IPA, MSO, or managed care environment is preferred.
A strong understanding of Medicare reimbursement and payer audit processes is preferred.
Ability to interpret complex clinical documentation is preferred.
Knowledge of utilization management, case management, and managed care operations is preferred.
Strong analytical, organizational, and problem-solving skills are preferred.
Ability to work independently and manage multiple priorities is preferred.
Excellent written and verbal communication skills are preferred.

The DRG Coder is responsible for reviewing inpatient medical records and accurately assigning diagnosis and procedure codes using ICD-10-CM and ICD-10-PCS to determine the appropriate Diagnosis-Related Group (DRG) assignment.

This role ensures coding accuracy, reimbursement integrity, and compliance with federal and state regulations, payer guidelines, and internal policies. In an Independent Practice Association (IPA) and Management Services Organization (MSO) environment, the DRG Coder partners with utilization management, care management, finance, and provider network teams to support accurate payment, risk adjustment, quality reporting, and medical expense analysis.

Review inpatient hospital records and assign accurate diagnosis and procedure codes
Determine the appropriate MS-DRG or APR-DRG assignment based on coding and clinical documentation
Conduct coding validation and auditing to ensure compliance with payer and regulatory requirements
Identify documentation gaps and communicate opportunities to providers, hospitals, and Clinical Documentation Improvement (CDI) teams
Analyze denials and underpayments related to coding and DRG assignment
Support retrospective and concurrent reviews of high-cost admissions and outlier cases
Collaborate with utilization management, case management, finance, and contracting teams to optimize reimbursement and cost containment
Assist with internal and external audits, including RAC, Medicare Advantage, Medicaid, and commercial payer reviews
Provide education and mentoring to coding staff and other stakeholders
Monitor changes in coding guidelines, reimbursement methodologies, and regulatory requirements
Prepare reports and summaries related to coding accuracy, financial impact, and audit findings
Maintain confidentiality and compliance with HIPAA and company policies
Other duties as assigned

Associate’s degree in Health Information Management, Nursing, or related field
Have at least 5 years of inpatient coding experience
Have at least 2 years of advanced DRG validation, auditing, or hospital reimbursement experience
Certifications One or more of the following required: • CCS, RHIA, or RHIT from American Health Information Management Association • CIC from AAPC
Have advanced knowledge of ICD-10-CM, ICD-10-PCS, MS-DRG, and APR-DRG methodologies
Proficiency in coding software, electronic medical records, and Microsoft Office applications

You're great for the role if:

Experience working with Medicare Advantage, Medicaid, and commercial health plans
Experience in a delegated IPA, MSO, or managed care environment
Have a strong understanding of Medicare reimbursement and payer audit processes
Ability to interpret complex clinical documentation
Knowledge of utilization management, case management, and managed care operations
Strong analytical, organizational, and problem-solving skills
Ability to work independently and manage multiple priorities
Excellent written and verbal communication skills.

About the Company

Astrana Health

Technology-enabled platform delivering value-based care

Astrana Health runs a physician-focused, technology-enabled care platform that supports providers in delivering proactive, preventive, value-based care. Its end-to-end system coordinates care across affiliated networks, a management services organization, and primary, specialty, and ancillary clinics to help more than 20,000 providers and over 1.6 million Americans in value-based arrangements. How it works: the proprietary platform connects clinicians, patients, and care settings, enabling proactive care planning, care coordination, and efficient delivery of services in primary and specialty care. The company differentiates itself by combining a large provider network, an MSO, and clinics with a single tech platform to scale value-based care and improve patient experiences and outcomes rather than relying on fragmented, fee-for-service models. Its goal is to create a healthcare system that delivers better care, better experiences, and better outcomes for all.

Company size: 501-1,000
Company stage: Not listed
Total funding: Not listed
Headquarters: Alhambra, CA
Founded: Not listed

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