DRG Coding Auditor; Icd-Cm, Ms-Drg, Ap-Drg, -Drg

DRG Coding Auditor (ICD-9/10CM, MS-DRG, AP-DRG, APR-DRG)

Join to apply for the DRG Coding Auditor role at Elevance Health.

$95,172.00/yr - $/yr

Colorado;
Illinois;
Maryland;
Minnesota;
Nevada

The DRG Coding Auditor audits inpatient medical records and generates high quality recoverable claims for the benefit of the company across all lines of business and clients. This role involves performing clinical reviews of medical records and documentation to evaluate coding and DRG assignment accuracy, including review of DRG coding via medical record and physician statements submitted by acute care hospitals.

• Analyze and audit claims by integrating medical chart coding principles, clinical guidelines and objectivity in performing medical audit activities.
• Draw on advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions.
• Utilize audit tools and workflow systems to make audit determinations and generate audit findings letters.
• Maintain accuracy and quality standards set by audit management.
• Identify new claim types and potential recoveries, such as re‑admissions, Inpatient to Outpatient, and HACs.
• Suggest and develop high‑quality, high‑value concept and process improvement and efficiency recommendations.

• Conduct virtual audits full‑time, with required in‑person training sessions.
• Perform clinical reviews of medical records for coding accuracy and DRG assignment.
• Generate audit findings letters and support recoverable claim submissions.

• At least one of the following: AA/AS or minimum 5 years of experience in claims auditing, quality assurance, or recovery auditing.
• Certification: RHIA, RHIT, CCS, or CIC.
• 5+ years experience working with ICD‑9/10CM, MS‑DRG, AP‑DRG and APR‑DRG.

• BA/BS preferred.
• Experience with vendor‑based DRG coding/clinical validation audit settings or hospital coding or QA environments preferred.
• Broad knowledge of medical claim billing, payer reimbursement policies, billing validation criteria, and coding terminology.
• Knowledge of plan policies and procedures across benefit program management, with emphasis in negotiation.

In addition to salary, Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase program, 401(k) contribution, and other benefits subject to eligibility requirements.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, and local laws.

Applicants requiring accommodation may contact elevancehealthj