DRG Coding Auditor

Hyra; United States; Remote; USD 85,000 - 115,000; Full time

Job summary

Elevance Health is seeking a DRG Coding Auditor to ensure accurate inpatient reimbursement and support member care. This is a remote role performing retrospective and prospective DRG audits, reviewing medical records and ICD-10-CM/PCS codes to validate MS-DRG/APR-DRG assignments.

You will collaborate with coders, clinicians, and compliance teams, prepare audit findings, and deliver education that improves coding quality.

Qualifications

• DRG coding expertise and accurate inpatient auditing
• Strong ICD-10-CM/PCS coding audit skills
• Experience with MS-DRG/APR-DRG grouping and documentation review
• Familiarity with Medicare/Medicaid regulatory requirements
• Ability to analyze data and identify root causes
• Proficient in EMR/EHR systems and Excel

Responsibilities

• Perform retrospective and prospective inpatient DRG coding audits for accuracy and compliance
• Review medical records, physician documentation, and codes (ICD-10-CM/PCS) to validate MS-DRG/APR-DRG assignment
• Identify coding, sequencing, and documentation issues impacting reimbursement and quality metrics
• Prepare clear audit findings, summaries, and education feedback for coders and providers
• Collaborate with coding, clinical, and compliance teams to resolve discrepancies and implement corrective actions
• Monitor trends, perform root cause analysis, and recommend process improvements to reduce coding errors
• Stay current on coding guidelines, payer rules, and regulatory changes impacting DRG assignment
• Support training, education, and quality initiatives aligned with Elevance Health's mission and policies

Skills

DRG coding

ICD-10-CM/PCS auditing

MS-DRG/APR-DRG grouping

clinical documentation review

Medicare/Medicaid regulations

data analysis

Job description

Elevance Health is seeking a DRG Coding Auditor to ensure accurate, compliant inpatient reimbursement and support whole-health care for our members. In this remote role, you will perform detailed retrospective and prospective DRG audits, reviewing medical records and ICD-10-CM/PCS codes to validate MS-DRG/APR-DRG assignments and identify documentation gaps. You'll collaborate with coders, clinicians, and compliance teams, prepare clear audit reports, and deliver education that improves coding quality. Join a mission-driven, inclusive culture with strong benefits, growth opportunities, and a focus on innovation, learning, and work-life balance.

Responsibilities

• Perform retrospective and prospective inpatient DRG coding audits for accuracy and compliance
• Review medical records, physician documentation, and codes (ICD-10-CM/PCS) to validate MS-DRG/APR-DRG assignment
• Identify coding, sequencing, and documentation issues impacting reimbursement and quality metrics
• Prepare clear audit findings, summaries, and education feedback for coders and providers
• Collaborate with coding, clinical, and compliance teams to resolve discrepancies and implement corrective actions
• Monitor trends, perform root cause analysis, and recommend process improvements to reduce coding errors
• Stay current on coding guidelines, payer rules, and regulatory changes impacting DRG assignment
• Support training, education, and quality initiatives aligned with Elevance Health's mission and policies

Required Skills

• DRG coding
• ICD-10-CM/PCSmedical record auditinginpatient coding
• MS-DRG/APR-DRG groupingclinical documentation review
• Medicare/Medicaid regulationscoding compliancedata analysisaudit reporting
• EHR systems
• Microsoft Excelroot cause analysisquality improvement
• HIPAA compliance