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

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

Base pay range: $95,172.00/yr - $/yr

Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.

Alternate locations may be considered if candidates reside within a commuting distance from an office.

• Analyze and audit claims by integrating medical chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities.
• Draw on advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions.
• Utilize audit tools and auditing workflow systems and reference information to make audit determinations and generate audit findings letters.
• Maintain accuracy and quality standards as set by audit management for the auditing concept, valid claim identification, and documentation purposes (e.g., letter writing).
• Identify new claim types by identifying potential claims outside of the concept where additional recoveries may be available, such as re-admissions, inpatient to outpatient, and HACs.
• Suggest and develop high quality, high value concepts and/or process improvement and efficiency recommendations.

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

• BA/BS preferred.
• Experience with vendor-based Diagnosis‑Related Group (DRG) Coding/Clinical Validation Audit setting, hospital coding, or quality assurance environment.
• Broad knowledge of medical claims billing/payment systems, provider billing guidelines, payer reimbursement policies, billing validation criteria, and coding terminology.
• Knowledge of plan policies and procedures in all facets of benefit programs management with heavy emphasis on negotiation.

Colorado;
Illinois;
Maryland;
Minnesota;
Nevada

Applicants who require accommodation to participate in the job application process may contact elevancehealthj for assistance.

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, or local laws.