DRG Coding Auditor Principal

Elevance Health (Anthem); Mason (OH); Hybrid; USD 122,000 - 183,000; Full time

Benefits offered by this job

Comprehensive benefits

Equity stock purchase

401k contribution

Job summary

Elevance Health is seeking a DRG Coding Auditor Principal to support virtual, full-time work with occasional in-person training. Roles may be located near a commuting office.

The position offers significant autonomy, high-level coding expertise, and opportunities to influence audit processes and recoveries. The candidate will analyze complex claims using ICD-10 guidelines and DRG concepts, produce audit findings, and collaborate with management to optimize criteria while maintaining rigorous

Qualifications

• Requires AA/AS or 15+ years in claims auditing.
• Requires RHIA/RHIT/CCS/CIC/CCDS certification.
• Minimum 10 years experience with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG.

Responsibilities

• Analyzes and audits claims using advanced coding principles and Official Guidelines.
• Uses ICD-10 expertise to substantiate audit conclusions.
• Uses audit tools and workflow systems to generate audit determinations and letters.
• Validates accuracy and quality standards per audit management guidance.
• Identifies new claim types and opportunities for recovery and process improvement.
• Operates largely independently with high-quality output and limited supervision.
• Collaborates with management to refine selection criteria.

Skills

ICD-9/10 Coding

DRG Auditing

Quality Assurance

Audit Tools

Education

RHIA/RHIT/CCS/CIC/CCDS certification

AA/AS or 15+ years experience

Job description

Anticipated End Date: 2026-09-25

Position Title

DRG Coding Auditor Principal

Job Description

Location: 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.

How you'll make a difference

• Analyzes and audits claims by integrating advanced or convoluted medical chart coding principles (found in the Official Coding Guidelines, Coding Clinics, and the ICD-10 Alphabetic and Tabular Indices), complex clinical guidelines and maintaining objectivity in the performance of medical audit activities.
• Draws on extremely advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate sophisticated conclusions.
• Utilizes audit tools and auditing workflow systems and reference information to make audit determinations and generate audit findings letters.
• Validates accuracy and quality standards as set by audit management for the auditing concept, valid claim identification, and documentation purposes (e.g., letter writing) on lower level auditors.
• Identifies new claim types by identifying potential claims outside of the concept where additional recoveries may be available, such as re-admissions, Inpatient to Outpatient, and Hospital Acquired Conditions (HACs), Preventable Adverse Events (PAEs) or Never Events. Suggests and develops high quality, high value concept and or process improvement and efficiency recommendations.
• Operates largely independently and autonomously with little oversight due to extremely high quality output and audit results that only the most advanced and experienced DRG Coding Auditors would understand.
• Performs secondary audits on claims that have been reviewed by other DRG Coders for missed opportunities and identifies gaps in foundational audit knowledge.
• Collaborates with management to improve selection criteria.

Minimum Requirements

• Requires at least one of the following: AA/AS or minimum of 15 years of experience in claims auditing, quality assurance, or recovery auditing.
• Requires at least one of the following certification: RHIA certification as a Registered Health Information Administrator, RHIT certification as a Registered Health Information Technician, CCS as a Certified Coding Specialist, CIC as a Certified Inpatient Coder, or Certified Clinical Documentation Specialist (CCDS).
• Requires minimum of 10 years experience working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG.

Preferred skills, qualifications and experience

• BA/BS preferred.
• Experience with vendor based DRG Coding / Clinical Validation Audit setting or hospital coding or quality assurance environment preferred. Broad, deep and niche knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, billing validation criteria and coding terminology strongly preferred.
• RN license strongly preferred.

Locations

Cleveland, OH; Columbus, OH; Virginia

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $122,240 to $183,360

In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).

The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company.

The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws .

*The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. T