Hybrid DRG Audit Manager - Lead Compliance & Strategy

Elevance Health, Inc.; United States; Hybrid; USD 115,000 - 207,000; Full time

Benefits offered by this job

Hybrid work model

Job summary

Elevance Health is seeking a DRG Coding Audit Manager to lead a team auditing inpatient records for accurate DRG assignments and regulatory compliance. You will identify coding discrepancies and drive opportunities for recoveries, partnering with clinical, compliance and data analytics teams.

This role requires a BA/BS and 5+ years in project/program management or related areas, with some travel. It operates in a hybrid model with in-office presence three days per week.

Qualifications

• BA/BS required with 5+ years in project/program management or related fields.
• Travel to worksite as necessary.

Responsibilities

• Sets the strategic direction for audit methodologies and oversees team development.
• Collaborates with clinical, compliance, provider engagement, and data analytics teams.
• Hires, trains, coaches, counsels, 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 for the program.
• Analyzes variance to program/project plan.
• Leads documentation to support business objectives and ensure consistency.

Skills

Inpatient coding

DRG auditing

Leadership experience

ICD-9/10CM knowledge

MS-DRG/APR-DRG knowledge

Education

BA/BS degree

Job description

Elevance Health is seeking a DRG Coding Audit Manager to lead a team auditing inpatient records for accurate DRG assignments and regulatory compliance. You will identify coding discrepancies and drive opportunities for recoveries, partnering with clinical, compliance and data analytics teams.

This role requires a BA/BS and 5+ years in project/program management or related areas, with some travel. It operates in a hybrid model with in-office presence three days per week.