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

DRG Coding Auditor

Elevance Health invites applications for a DRG Coding Auditor responsible for auditing inpatient medical records and generating high quality recoverable claims across all lines of business and client accounts. The role focuses on clinical reviews of medical records, ensuring accurate ICD‑10 coding, DRG assignment and identifying new recovery opportunities.

• Analyze and audit claims by integrating medical chart coding principles, clinical guidelines and audit workflow systems.
• Apply advanced ICD‑10 coding expertise and clinical guidelines to substantiate audit conclusions.
• Utilize audit tools and reference information to generate audit findings letters and document audit determinations.
• Maintain quality and accuracy standards set by audit management for valid claim identification and documentation.
• Identify new claim types and recovery opportunities such as re‑admissions, inpatient‑to‑outpatient transitions and HACs.
• Suggest and develop process improvement recommendations to increase audit value and efficiency.

• At least 5 years of experience in claims auditing, quality assurance, or recovery auditing, or an AA/AS degree with equivalent experience.
• Certification: RHIA, RHIT, CCS, or CIC.
• Extensive experience (5+ years) with ICD‑9/10CM, MS‑DRG, AP‑DRG, and APR‑DRG coding.

• BA or BS degree.
• Background in vendor‑based DRG coding or hospital coding environments.
• Proficiency with medical claims billing, payer policies, and coding terminology.
• Knowledge of benefit program management and negotiation processes.

Elevance Health offers a comprehensive benefits package, including health, dental, vision, disability, 401k with match, equity stock purchase, and various incentive and recognition programs. Benefit eligibility is subject to company policies and regulatory requirements.

Positions located in Colorado, Illinois, Maryland, Minnesota, and Nevada. Remote work is virtual full‑time with occasional in‑person training sessions.

Elevance Health is an Equal Employment Opportunity employer. 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 protected status. Applicants requiring accommodation may contact elevancehealthj