Hybrid Inpatient DRG Coding Audit Lead

Elevance Health; Washington (District of Columbia); Hybrid; USD 115,000 - 207,000; Full time

Job summary

Elevance Health is seeking a DRG Coding Audit Manager to lead an auditing team responsible for inpatient medical records and DRG assignments. The role focuses on identifying coding discrepancies and recoverable opportunities while supporting regulatory integrity for clients.

The candidate will set audit methodologies, collaborate across clinical, compliance, and analytics teams, and develop metrics and reporting tools to drive program success.

Qualifications

• BA/BS degree and at least 5 years in project/program management or related fields.
• Travel to worksite as needed.
• Experience in healthcare coding or DRG auditing preferred.

Responsibilities

• Sets strategic direction for audit methodologies and oversees team development.
• Collaborates cross-functionally 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 program/project reporting tools.
• Analyzes variance to program/project plan.
• Leads documentation to support business objectives and ensure consistency.
• Champions local stakeholders and tactical decision-makers.
• Suggests and develops high-quality, high-value process improvements.
• Draws on advanced ICD-10 coding expertise to substantiate conclusions.

Skills

DRG auditing

Project management

Leadership

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 an auditing team responsible for inpatient medical records and DRG assignments. The role focuses on identifying coding discrepancies and recoverable opportunities while supporting regulatory integrity for clients.

The candidate will set audit methodologies, collaborate across clinical, compliance, and analytics teams, and develop metrics and reporting tools to drive program success.