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

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

Elevance Health is seeking a DRG Coding Auditor to audit inpatient medical records and create recoverable claims across all lines of business. The role is primarily virtual with required in‑person training sessions.

$95,172.00/yr - $/yr

• Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines and objectivity in the performance of medical audit activities.
• Draws on advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions.
• Utilizes audit tools and auditing workflow systems and reference information to make audit determinations and generate audit findings letters.
• Maintains accuracy and quality standards as set by audit management for the auditing concept, valid claim identification, and documentation purposes (e.g., letter writing).
• Identifies 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.
• Suggests and develops high quality, high value concept and or process improvement and efficiency recommendations.

• Requires at least one of the following: AA/AS or minimum of 5 years of experience in claims auditing, quality assurance, or recovery auditing.
• Requires at least one of the following certifications: RHIA certification as a Registered Health Information Administrator and/or RHIT certification as a Registered Health Information Technician and/or CCS as a Certified Coding Specialist and/or CIC as a Certified Inpatient Coder.
• Requires 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 or hospital coding or quality assurance environment preferred.
• Broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, billing validation criteria and coding terminology preferred.
• Knowledge of Plan policies and procedures in all facets of benefit programs management with heavy emphasis in negotiation preferred.

Locations:
Colorado;
Illinois;
Maryland;
Minnesota;
Nevada. The position is virtual full‑time with required onsite training sessions. Candidates outside a reasonable commuting distance will not be considered unless accommodation is granted.

Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution.

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.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health.

For certain patient/member‑facing roles, candidates must be vaccinated against COVID‑19 and Influenza.