DRG Coding Auditor – MS/APR-DRG (Remote)

ANTHEM INSURANCE COMPANIES INC; Indianapolis (IN); Remote; USD 93,000 - 160,000; Full time

Job summary

ANTHEM INSURANCE COMPANIES INC. is seeking a DRG Coding Auditor to audit inpatient medical records and generate high-quality recoverable claims across lines of business.

The role emphasizes DRG assignment accuracy through ICD-10 coding expertise and clinical guideline application. You will perform medical record reviews, develop audit findings, and identify opportunities for additional recoveries, including readmissions and HACs.

Qualifications

• AA/AS or equivalent required or 5+ years in claims auditing.
• RHIA, RHIT, CCS, CIC, or CCDS certification may be required or preferred.
• 5 years of experience with ICD-9/10CM, MS-DRG, AP-DRG & APR-DRG.

Responsibilities

• Analyzes and audits claims by applying medical chart coding principles and clinical guidelines.
• Uses ICD-10 coding expertise to substantiate audit conclusions.
• Utilizes auditing tools and systems to determine audit findings and letters.
• Maintains accuracy and quality standards for auditing concepts and documentation.
• Identifies new claim types for potential additional recoveries (readmissions, HACs, etc.).
• Suggests process improvements and efficiency opportunities.

Skills

ICD-10 coding

Auditing

Medical claims

Education

AA/AS or equivalent

BA/BS preferred

Job description

ANTHEM INSURANCE COMPANIES INC. is seeking a DRG Coding Auditor to audit inpatient medical records and generate high-quality recoverable claims across lines of business.

The role emphasizes DRG assignment accuracy through ICD-10 coding expertise and clinical guideline application. You will perform medical record reviews, develop audit findings, and identify opportunities for additional recoveries, including readmissions and HACs.