Lead Inpatient DRG Audit Manager (Hybrid)

Elevance Health; Mason (OH); Hybrid; USD 115,000 - 207,000; Full time

Job summary

Elevance Health leads a DRG coding audit program to ensure inpatient DRG accuracy and regulatory compliance across multiple locations. The role guides audit methodologies, analyzes trends, and partners with clinical, compliance, and data analytics teams to drive value for the company and clients.

The position requires a BA/BS and 5+ years in project management or related areas, with preferred inpatient coding/DRG experience, and travel as needed in a hybrid work environment.

Qualifications

• Requires BA/BS and minimum 5 years experience in project/program management, process reengineering, organizational design, and/or implementation; travels to worksite as necessary.

Responsibilities

• Sets the strategic direction for audit methodologies and ensures audits meet best practices and payer requirements.
• Collaborates cross-functionally with clinical, compliance, provider engagement, and data analytics teams.
• Hires, trains, coaches, 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/project.
• Analyzes variance to the project plan.
• Builds documentation to support business objectives and consistency.

Skills

Project management

Leadership

Process reengineering

Organizational design

Education

BA/BS

Tools

ICD-9/10CM

MS-DRG

APR-DRG

Job description

Elevance Health leads a DRG coding audit program to ensure inpatient DRG accuracy and regulatory compliance across multiple locations. The role guides audit methodologies, analyzes trends, and partners with clinical, compliance, and data analytics teams to drive value for the company and clients.

The position requires a BA/BS and 5+ years in project management or related areas, with preferred inpatient coding/DRG experience, and travel as needed in a hybrid work environment.