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

ANTHEM INSURANCE COMPANIES INC; Costa Mesa (CA); Remote; USD 93,000 - 160,000; Full time

Benefits offered by this job

Sign-on bonus

Job summary

Anthem Insurance Companies Inc is seeking a DRG Coding Auditor specialized in MS-DRG and APR-DRG to audit inpatient medical records and generate high-quality recoverable claims across lines of business.

The role requires advanced ICD-10 coding expertise, clinical guideline application, and the ability to document audit findings clearly. Virtual/work-from-home options are available with required in-person training sessions. California preferred locations considered.

Qualifications

• Requires AA/AS or 5+ years in claims auditing or recovery auditing.
• Certifications in RHIA/RHIT/CCS/CIC/CCDS preferred.
• 5 years' experience with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG.

Responsibilities

• Audit inpatient medical records to generate high-quality, recoverable claims.
• Perform clinical reviews to evaluate coding accuracy and DRG assignment.
• Use ICD-10 coding principles and guidelines to substantiate audit conclusions.
• Draft audit findings letters and maintain documentation standards.
• Identify new claim opportunities for additional recoveries.

Skills

ICD-10 Coding Expertise

MS-DRG/AP-DRG/APR-DRG Knowledge

Claims Auditing

Clinical Documentation Review

Education

AA/AS or 5+ years experience in claims auditing

BA/BS preferred

Tools

Vendor DRG Coding Tools

Job description

Anthem Insurance Companies Inc is seeking a DRG Coding Auditor specialized in MS-DRG and APR-DRG to audit inpatient medical records and generate high-quality recoverable claims across lines of business.

The role requires advanced ICD-10 coding expertise, clinical guideline application, and the ability to document audit findings clearly. Virtual/work-from-home options are available with required in-person training sessions. California preferred locations considered.