Coding Auditor Senior

The Elevance Health Companies, Inc.; St. Louis (MO); Hybride; USD 90 000 - 125 000; Plein temps

Avantages offerts par ce poste

merit increases

paid holidays

Paid Time Off

incentive bonus programs

medical

dental

vision

short and long term disability

401(k) +match

stock purchase plan

life insurance

welfare programs

financial education resources

Résumé du poste

Elevance Health is seeking a Coding Auditor Senior to audit diagnosis data from physician and hospital records to ensure proper ICD-9/ICD-10 coding and compliance with risk adjustment requirements.

The role supports hybrid/virtual work with in-person training sessions and requires at least a high school diploma with 3 years of medical coding experience and a certified coder credential. Strong communication and knowledge of Medicare Advantage are preferred.

Qualifications

• Requires a high school diploma or equivalent and minimum of 3 years of experience as coder of medical records in physician office, hospital, or insurance/coding office setting.
• Medical Coder certification from an accredited source is required.

Responsabilités

• Audits diagnosis data retrieved from physician and hospital medical records and/or data extract files for revenue projects and RADV.
• Assists with National and Targeted Risk Adjustment Data Validation audits.
• Participates and represents the department in business leadership groups.
• Serves as a subject matter expert.
• Assesses and identifies training opportunities.
• Maintains current knowledge of requirements and guidance for audit duties.

Connaissances

Strong communication skills

Medicare Advantage experience

Formation

H.S. diploma or equivalent

Medical Coder certification

Description du poste

Position Title: Coding Auditor Senior

Anticipated End Date: 2026-11-29

Job Description: Coding Auditor Senior

Location: Any PulsePoint office. St. Louis, MO preferred. Virtual: This role enables associates to work virtually full-time, except for 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. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law.

The Coding Auditor Senior is responsible for auditing diagnosis data collected from physician and hospital medical records to ensure proper ICD-9/ICD-10 coding and compliance with risk adjustment requirements.

How you will make an impact:

• Audits diagnosis data retrieved from physician and hospital medical records and/or data extract files for both revenue project and RADV.
• Assists with National and Targeted Risk Adjustment Data Validation audits.
• Participates and represents the department in business leadership groups.
• Serves as a subject matter exert.
• Assesses and identifies training opportunities.
• Maintains current knowledge of requirements and guidance required in the performance of audit duties.

Minimum Requirements:

• Requires a H.S. diploma or equivalent and minimum of 3 years of experience as coder of medical records in physician office, hospital, or insurance/coding office setting; or any combination of education and experience, which would provide an equivalent background.
• Medical Coder certification from accredited source (e.g. American Health Information Management Association, American Academy of Professional Coders or Practice Management Institute) required.

Preferred Skills, Capabilities and Experiences:

• BS in health sciences, health management or related field preferred.
• Experience working with Medicare Advantage preferred.
• Experience with ICD-9 coding a plus.
• HCC coding preferred.
• Strong communication skills preferred.

Job Level: Non-Management Non-Exempt

Workshift: 1st Shift (United States of America)

Job Family: MED > Licensed/Certified - Other

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

Benefits

• merit increases
• paid holidays
• Paid Time Off
• incentive bonus programs (unless covered by a collective bargaining agreement)
• medical
• dental
• vision
• short and long term disability benefits
• 401(k) +match
• stock purchase plan
• life insurance
• welfare programs
• financial education resources
• to name a few

Hybrid Workforce Strategy

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

Vaccination Policy

We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Equal Employment Opportunity

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.

Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact.

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.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.

Posting Information

NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words — the job is posted until 3/13, not through 3/13.

Company Background

Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.

Join our Talent Community and stay connected with company news, information, and future job opportunities. Fueled by our bold purpose to improve the health of humanity, we are transforming from a traditional health benefits organization into a lifetime trusted health partner.

Our nearly 100,000 associates serve approximately 100M+ people, at every stage of health. We address a full range of needs with an integrated whole health approach, powered by industry-leading capabilities and a digital platform for health.

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.

Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact.

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.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.

Please visit the Contract Worker Community Page.

Elevance Health is an Equal Opportunity Employer/Disability/Veterans.