Manager of DRG Coding & Clinical Validation Audit

Elevance Health; Indianapolis (IN); Hybrid; USD 115,020 - 207,216; Full time

Benefits offered by this job

Benefits package

Job summary

Elevance Health is seeking a Manager of DRG Coding Audit-Program/Project to lead a high‑performing team auditing inpatient records for DRG accuracy and regulatory integrity across the organization and clients.

The role sets audit strategy, partners with clinical, compliance, provider engagement and data analytics, hires and coaches staff, analyzes trends, designs scope, and builds metrics and reporting tools to drive high‑value improvements in coding governance.

Qualifications

• BA/BS degree required; minimum 5 years in project/program management, process reengineering, organizational design, or implementation.
• Will travel to worksite and other locations as necessary.
• Experience leading DRG/inpatient auditing and cross-functional teams is a plus.

Responsibilities

• Set strategic direction for audit methodologies and ensure audits meet best practices.
• Collaborate with clinical, compliance, provider engagement, and data analytics teams.
• Hire, train, coach, and evaluate performance of direct reports.
• Analyze audit trends and DRG shifts to inform strategy and actions.
• Plan program scope and design, and develop reporting metrics.
• Lead documentation efforts to support business objectives and ensure consistency.

Skills

Project management

Process reengineering

Organizational design

Implementation

Leadership

Education

BA/BS degree

Job description

Manager of DRG Coding Audit-Program/Project

Locations: The selected candidate must reside within a reasonable commuting distance of the designated posting locations: Virginia, Indiana, Georgia, Ohio, Maryland, New Jersey, New York and Texas. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Hybrid 2: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. 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 an accommodation is granted as required by law.

The Managers of DRG Coding & Clinical Validation leads a high‑performing team responsible for auditing inpatient medical records to ensure the accuracy and compliance of Diagnosis-Related Group (DRG) assignments. This role plays a critical part in identifying coding discrepancies and recoverable claim opportunities, and supporting regulatory integrity on behalf of the company and its clients.

How You Will Make An Impact

• Sets the strategic direction for audit methodologies, oversees team development, and ensures that audits meet the industry’s best practices and payer‑specific requirements.
• Collaborates cross-functionally with clinical, compliance, provider engagement, and data analytics teams to align audit insights with broader program goals.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.
• Analysis of audit trends, DRG shifts, and using 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 building of documentation to support business objectives and ensure consistency.
• Responsible for championing local stakeholders and tactical decision-makers.
• Suggests and develops high quality, high value concept and or process improvement and efficiency recommendations.
• Draws on advanced ICD‑10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions.

Minimum Requirements

• Requires a BA/BS and minimum of 5 years experience in project/program management, process reengineering, organizational design, and/or implementation; or any combination of education and experience, which would provide an equivalent background. Travels to worksite and other locations as necessary.

Preferred Skills, Capabilities And Experiences

• Preferred experience includes a minimum of 5‑7 years of inpatient coding or DRG auditing experience, including 2‑3 years in a leadership or supervisory capacity.
• Experience working with ICD‑9/10CM, MS‑DRG and APR‑DRG.
• Broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, billing validation criteria and coding terminology preferred.

Salary range: $115,020 to $207,216 for candidates in the following locations: Maryland; Cleveland, OH; Columbus, OH; New Jersey, New York and Virginia.

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. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company’s sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

Hybrid Workforce Strategy: Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, and local laws. Applicants who require accommodation to participate in the job application process may contact [e-mail] for assistance.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.