DRG Coding Audit Lead – Inpatient Compliance & Strategy

Elevance Health; Port Reading (NJ); Hybrid; USD 115,000 - 207,000; Full time

Job summary

Elevance Health is seeking a DRG Coding Audit Manager to lead a high-performing team responsible for auditing inpatient medical records and ensuring the accuracy of DRG assignments and regulatory integrity. The role collaborates with clinical, compliance, provider engagement and analytics teams and reports to the program leadership.

The position is Hybrid, requiring three days in-office per week, with location options in NJ/NY/MD/OH/VA/MI and other posted locations.

Qualifications

• Requires a BA/BS and minimum of 5 years experience in project/program management, process reengineering, organizational design, and/or implementation; or any combination of education and experience, which would provide an equivalent background.
• Minimum 5–7 years of inpatient coding or DRG auditing experience, including 2–3 years in a leadership or supervisory capacity.
• Experience working with ICD-9/10CM, MS-DRG and APR-DRG.
• Broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, billing validation criteria and coding terminology preferred.

Responsibilities

• Sets the strategic direction for audit methodologies and oversees team development.
• Collaborates cross-functionally with clinical, compliance, provider engagement and analytics teams.
• Hires, trains, coaches and evaluates performance of direct reports.
• Analyzes audit trends, DRG shifts and uses financial outcomes to inform strategy.
• Plans program/project scope and design.
• Develops metrics and reporting tools.
• Leads building of documentation to support business objectives.
• Champions local stakeholders and tactical decisions.
• Proposes process improvements and efficiency recommendations.
• Draws on advanced ICD-10 coding expertise to substantiate conclusions.

Skills

Inpatient coding or DRG auditing

Leadership / Supervisory

ICD-9/10CM knowledge

Billing guidelines knowledge

Education

BA/BS degree

Tools

ICD-9/10CM

MS-DRG

APR-DRG

Job description

Elevance Health is seeking a DRG Coding Audit Manager to lead a high-performing team responsible for auditing inpatient medical records and ensuring the accuracy of DRG assignments and regulatory integrity. The role collaborates with clinical, compliance, provider engagement and analytics teams and reports to the program leadership.

The position is Hybrid, requiring three days in-office per week, with location options in NJ/NY/MD/OH/VA/MI and other posted locations.